Healthcare Provider Details

I. General information

NPI: 1255479531
Provider Name (Legal Business Name): COUNSELING COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BEDFORD ST #125
LEXINGTON MA
02420
US

IV. Provider business mailing address

57 BEDFORD ST #125
LEXINGTON MA
02420
US

V. Phone/Fax

Practice location:
  • Phone: 781-861-1818
  • Fax: 781-861-2057
Mailing address:
  • Phone: 781-861-1818
  • Fax: 781-861-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMA

VIII. Authorized Official

Name: MRS. JANE D ADOLPH
Title or Position: PARTNER COUNSELING COLLABORATIVE
Credential: LICSW
Phone: 781-861-1818