Healthcare Provider Details

I. General information

NPI: 1467911990
Provider Name (Legal Business Name): TLJ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25W OLD WESTPORT RD
DARTMOUTH MA
02747-2513
US

IV. Provider business mailing address

22 ONYX DR
DARTMOUTH MA
02747-3521
US

V. Phone/Fax

Practice location:
  • Phone: 508-982-4755
  • Fax: 877-308-2202
Mailing address:
  • Phone: 508-982-4755
  • Fax: 877-308-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ILENE G LEVINE
Title or Position: OWNER
Credential: LMHC
Phone: 508-982-4755