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General NPI Number Information
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NPI Number | 1679216907
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Entity Type | Organization
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Legal Business Name | BALANCED LIFE COUNSELING
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 300 ANDOVER ST STE 255
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City | PEABODY
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State | MA
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Zip | 01960-1526
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Country | US
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Telephone | 781-435-7510
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Fax |
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Provider Business Mailing Address
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Address Line | 300 ANDOVER ST STE 255
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City | PEABODY
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State | MA
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Zip | 01960-1526
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Country | US
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Telephone | 978-530-7735
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | KERRY CARBONE
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Credential | LMHC
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Telephone | 978-530-7735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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