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General NPI Number Information
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NPI Number | 1104565589
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN COUNSELING ASSOCIATES
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 328 BROADWAY STE 212
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City | LYNN
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State | MA
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Zip | 01904-2654
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Country | US
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Telephone | 781-632-0586
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Fax |
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Provider Business Mailing Address
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Address Line | 110 PARK AVE W APT E9
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City | LOWELL
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State | MA
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Zip | 01852-3676
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Country | US
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Telephone | 781-632-0586
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | COURTNEY SPEROPOLOUS
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Credential | LMHC
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Telephone | 781-632-0586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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