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General NPI Number Information
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NPI Number | 1851994883
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Entity Type | Organization
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Legal Business Name | CULTIVATE CONSCIOUSLY WELLNESS COUNSELING, LLC
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 210 PARK AVE STE 231
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City | WORCESTER
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State | MA
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Zip | 01609-2246
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Country | US
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Telephone | 508-659-2380
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Fax | 774-243-0597
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Provider Business Mailing Address
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Address Line | 210 PARK AVE STE 231
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City | WORCESTER
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State | MA
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Zip | 01609-2246
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Country | US
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Telephone | 508-659-2380
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Fax | 774-243-0597
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Authorized Official
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Title or Position | FOUNDER
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Name | CRISTEN ELAINA SMITH
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Credential | LMHC, LPC, BC-TMH
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Telephone | 508-669-7166
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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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