Healthcare Provider Details

I. General information

NPI: 1295215325
Provider Name (Legal Business Name): WORTH IN CHRIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 DUDLEY ST
ROXBURY MA
02119-2769
US

IV. Provider business mailing address

604 FREEPORT ST # 5
BOSTON MA
02122-3205
US

V. Phone/Fax

Practice location:
  • Phone: 617-917-4149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number120804
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number120804
License Number StateMA

VIII. Authorized Official

Name: SHAMEKA GREGORY
Title or Position: OWNER
Credential:
Phone: 617-917-4149