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General NPI Number Information
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NPI Number | 1356187470
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Entity Type | Organization
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Legal Business Name | WANDER WELL COUNSELING, PLLC
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 37 CRANBERRY FARM RD
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City | PLYMOUTH
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State | MA
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Zip | 02360-2279
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Country | US
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Telephone | 508-503-9110
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Fax |
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Provider Business Mailing Address
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Address Line | 14 TOBEY RD STE G UNIT 162
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City | WAREHAM
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State | MA
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Zip | 02571
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Country | US
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Telephone | 508-503-9110
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Fax | 508-484-4499
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | MS. SHANON LARSON
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Credential | LICSW
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Telephone | 508-503-9110
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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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