Healthcare Provider Details

I. General information

NPI: 1629835095
Provider Name (Legal Business Name): HEALING TRAUMA CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 8TH ST FL 1
NEW BEDFORD MA
02740-6003
US

IV. Provider business mailing address

150 8TH ST
NEW BEDFORD MA
02740-6003
US

V. Phone/Fax

Practice location:
  • Phone: 774-328-8718
  • Fax: 774-202-2826
Mailing address:
  • Phone: 774-328-8718
  • Fax: 774-202-2826

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KIM CHRISTINE SPOONER
Title or Position: EXECUTIVE DIRECTOR
Credential: LMHC
Phone: 774-328-8718