Healthcare Provider Details

I. General information

NPI: 1801480769
Provider Name (Legal Business Name): PLYMOUTH SOLACE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 RESNIK RD STE 207
PLYMOUTH MA
02360-5381
US

IV. Provider business mailing address

6 RESNIK RD STE 207
PLYMOUTH MA
02360-5381
US

V. Phone/Fax

Practice location:
  • Phone: 508-591-0221
  • Fax:
Mailing address:
  • Phone: 508-591-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GOODWIN
Title or Position: LMHC
Credential: MA
Phone: 508-591-0221