Healthcare Provider Details

I. General information

NPI: 1316167554
Provider Name (Legal Business Name): ATLANTIC COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 ACUSHNET AVE
NEW BEDFORD MA
02745-4614
US

IV. Provider business mailing address

4364 ACUSHNET AVE
NEW BEDFORD MA
02745-4614
US

V. Phone/Fax

Practice location:
  • Phone: 508-998-2700
  • Fax: 508-998-2176
Mailing address:
  • Phone: 508-998-2700
  • Fax: 508-998-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY J FORBUSH
Title or Position: CLINICAL SOCIAL WORKER PARTNER
Credential: LICSW
Phone: 508-998-2700