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General NPI Number Information
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NPI Number | 1023747680
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Entity Type | Organization
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Legal Business Name | GAIA COUNSELING CENTER LLC
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 325 MAIN ST
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City | WEST NEWBURY
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State | MA
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Zip | 01985-1418
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Country | US
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Telephone | 978-270-6985
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Fax |
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Provider Business Mailing Address
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Address Line | 325 MAIN ST
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City | WEST NEWBURY
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State | MA
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Zip | 01985-1418
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Country | US
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Telephone | 978-270-6985
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | MR. MICHAEL MAYO
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Credential | LICSW, MSW
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Telephone | 978-270-6985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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