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General NPI Number Information
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NPI Number | 1922646272
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTER AT MILLBURY LLC
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 29 MAIN ST STE 300
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City | MILLBURY
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State | MA
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Zip | 01527-2005
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Country | US
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Telephone | 508-785-4490
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Fax | 508-785-4985
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Provider Business Mailing Address
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Address Line | PO BOX 27028
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City | NEWARK
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State | NJ
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Zip | 07101-6728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSEPH M CHELALES
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Credential |
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Telephone | 508-785-4490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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