Healthcare Provider Details

I. General information

NPI: 1902354640
Provider Name (Legal Business Name): NORTH SHORE WELLNESS & THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LINDALL ST
DANVERS MA
01923-2135
US

IV. Provider business mailing address

80 LINDALL ST
DANVERS MA
01923-2135
US

V. Phone/Fax

Practice location:
  • Phone: 978-406-4234
  • Fax: 978-921-2968
Mailing address:
  • Phone: 978-406-4234
  • Fax: 978-921-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID L SMITH
Title or Position: MANAGING PARTNER
Credential:
Phone: 978-406-4234