Healthcare Provider Details

I. General information

NPI: 1760583736
Provider Name (Legal Business Name): INTERACTIONS COUNSELING AND INTERVENTION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 LITTLETON RD
WESTFORD MA
01886-3536
US

IV. Provider business mailing address

288 LITTLETON RD STE 30
WESTFORD MA
01886-3527
US

V. Phone/Fax

Practice location:
  • Phone: 978-392-9600
  • Fax: 978-486-8104
Mailing address:
  • Phone: 978-392-9600
  • Fax: 978-486-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARI JAN BENNETT
Title or Position: PRESIDENT
Credential: MSW
Phone: 978-392-9600