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General NPI Number Information
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NPI Number | 1962862425
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Entity Type | Organization
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Legal Business Name | THE HEALING JOURNEY LLC
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 25 S. WEST ST.
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City | NUNDA
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State | NY
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Zip | 14517-0614
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Country | US
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Telephone | 585-281-9947
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 694 25 S. WEST ST.
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City | NUNDA
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State | NY
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Zip | 14517-0694
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Country | US
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Telephone | 585-281-9947
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEANNE MATOSSIAN
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Credential | LCSW-R
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Telephone | 585-281-9947
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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 | 077265-1
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License Number State | NY
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