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General NPI Number Information
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NPI Number | 1467990846
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Entity Type | Organization
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Legal Business Name | NORTHEAST COUNSELING ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 39 HAVERHILL ST
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City | METHUEN
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State | MA
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Zip | 01844-4203
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Country | US
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Telephone | 978-804-4068
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Fax |
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Provider Business Mailing Address
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Address Line | 39 HAVERHILL ST
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City | METHUEN
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State | MA
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Zip | 01844-4203
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Country | US
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Telephone | 978-804-4068
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MR. SCOTT D WALLACE
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Credential | MSW, LICSW
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Telephone | 978-804-4068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 116999
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License Number State | MA
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