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General NPI Number Information
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NPI Number | 1366923005
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Entity Type | Organization
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Legal Business Name | COLLECTIVE COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 290 TURNPIKE RD STE 5-138
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City | WESTBOROUGH
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State | MA
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Zip | 01581-2843
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Country | US
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Telephone | 508-418-6608
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Fax | 508-475-9396
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Provider Business Mailing Address
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Address Line | 290 TURNPIKE RD STE 5-138
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City | WESTBOROUGH
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State | MA
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Zip | 01581-2843
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Country | US
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Telephone | 508-479-5202
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Fax | 508-475-9396
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Authorized Official
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Title or Position | OWNER
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Name | KELLEY A SMITH
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Credential | LICSW
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Telephone | 508-479-5202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 121289
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License Number State | MA
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