Healthcare Provider Details

I. General information

NPI: 1164092334
Provider Name (Legal Business Name): GOLDEN EDGE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MILLBROOK ST STE 506
WORCESTER MA
01606-2846
US

IV. Provider business mailing address

PO BOX 365
RUTLAND MA
01543-0365
US

V. Phone/Fax

Practice location:
  • Phone: 774-437-6753
  • Fax:
Mailing address:
  • Phone: 603-498-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MEGHAN BUCKLEY MCINTIRE
Title or Position: LICENSED MENTAL HEALTH CLINICIAN
Credential: LMHC
Phone: 603-498-6398