Healthcare Provider Details

I. General information

NPI: 1083985972
Provider Name (Legal Business Name): WHOLE LIFE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N MAIN ST
SHARON MA
02067-1172
US

IV. Provider business mailing address

450 N MAIN ST
SHARON MA
02067-1172
US

V. Phone/Fax

Practice location:
  • Phone: 508-648-1793
  • Fax:
Mailing address:
  • Phone: 508-648-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114970
License Number StateMA

VIII. Authorized Official

Name: MS. PATRICIA ADAMS KISSINGER
Title or Position: PSYCHOTHERAPIST
Credential: LICSW
Phone: 508-648-1793