Healthcare Provider Details

I. General information

NPI: 1942907191
Provider Name (Legal Business Name): HEALING WELLNESS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SUZANNAH ROAD
NORTH BILLERICA MA
01862
US

IV. Provider business mailing address

6 SUZANNAH ROAD
NORTH BILLERICA MA
01862
US

V. Phone/Fax

Practice location:
  • Phone: 978-431-0468
  • Fax:
Mailing address:
  • Phone: 978-431-0468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE EVELYN MAHONEY
Title or Position: OWNER/CLINICIAN
Credential: MA LMHC 12999-MH-CC
Phone: 978-431-0468