Healthcare Provider Details

I. General information

NPI: 1477282143
Provider Name (Legal Business Name): GEMINI MENTAL HEALTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ARNOLD RD
FISKDALE MA
01518-1145
US

IV. Provider business mailing address

25 ARNOLD RD
FISKDALE MA
01518-1145
US

V. Phone/Fax

Practice location:
  • Phone: 508-414-8382
  • Fax:
Mailing address:
  • Phone: 508-414-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JOYCE ELIZABETH WICKMAN
Title or Position: OWNER
Credential: LMHC
Phone: 508-414-8382