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General NPI Number Information
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NPI Number | 1477159309
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Entity Type | Organization
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Legal Business Name | C&C COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 11 MELBOURNE AVE
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City | NEWTONVILLE
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State | MA
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Zip | 02460-1221
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Country | US
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Telephone | 339-224-4394
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Fax | 339-204-9371
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Provider Business Mailing Address
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Address Line | 11 MELBOURNE AVE
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City | NEWTONVILLE
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State | MA
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Zip | 02460-1221
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Country | US
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Telephone | 339-224-0391
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. JASON M AYLSWORTH
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Credential | LMHC
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Telephone | 339-224-4394
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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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