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General NPI Number Information
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NPI Number | 1265824940
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Entity Type | Organization
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Legal Business Name | NEW DAWN INTEGRATED BEHAVIORAL HEALTH CENTER INC.
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 33 ELECTRIC AVE SUITE3B
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City | FITCHBURG
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State | MA
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Zip | 01420-7954
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Country | US
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Telephone | 978-627-3929
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Fax | 978-400-5328
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Provider Business Mailing Address
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Address Line | 33 ELECTRIC AVE SUITE3B
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City | FITCHBURG
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State | MA
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Zip | 01420-7954
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Country | US
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Telephone | 978-627-3929
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Fax | 978-400-5328
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHEILA RENEE WELLS
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Credential | CLINICAL NURSE SPECI
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Telephone | 978-627-3929
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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 | RN 174905
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License Number State | MA
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