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General NPI Number Information
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NPI Number | 1821262189
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Entity Type | Organization
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Legal Business Name | COMMON GROUND COUNSELING & PERSONAL GROWTH CENTER, LLC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 22 STEEPLE STREET SUITE 2053
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City | MASHPEE
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State | MA
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Zip | 02649
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Country | US
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Telephone | 508-477-3600
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Fax | 508-477-3711
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Provider Business Mailing Address
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Address Line | 22 STEEPLE STREET SUITE 2053
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City | MASHPEE
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State | MA
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Zip | 02649
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Country | US
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Telephone | 508-477-3600
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Fax | 508-477-3711
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Authorized Official
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Title or Position | SOLE MBR
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Name | MR. JOSEPH F DOWICK
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Credential | LICSW
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Telephone | 508-477-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 160572
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 113878
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License Number State | MA
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