Healthcare Provider Details

I. General information

NPI: 1972084119
Provider Name (Legal Business Name): HEALING JOURNEY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 08/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 RUSSELL ST UNIT 1
CAMBRIDGE MA
02140-1310
US

IV. Provider business mailing address

40 RUSSELL ST UNIT 1
CAMBRIDGE MA
02140-1310
US

V. Phone/Fax

Practice location:
  • Phone: 781-789-6592
  • Fax:
Mailing address:
  • Phone: 781-789-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number10524
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number10524
License Number StateMA

VIII. Authorized Official

Name: MS. KATHRYN Z LOBEL
Title or Position: COUNSELOR
Credential: LMHC
Phone: 781-789-6592