Healthcare Provider Details

I. General information

NPI: 1568376960
Provider Name (Legal Business Name): ALIGN IDENTITY COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WORCESTER RD
WEBSTER MA
01570-2101
US

IV. Provider business mailing address

77 WORCESTER RD
WEBSTER MA
01570-2101
US

V. Phone/Fax

Practice location:
  • Phone: 508-640-5797
  • Fax:
Mailing address:
  • Phone: 508-640-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: THEODORE M NG
Title or Position: OWNER
Credential: LICSW
Phone: 508-640-5797