Provider Demographics
NPI:1093106254
Name:ISLAND COUNSELING CENTER
Entity Type:Organization
Organization Name:ISLAND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL INTERN
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-693-7908
Mailing Address - Street 1:377 STATE RD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-7212
Mailing Address - Country:US
Mailing Address - Phone:508-693-7908
Mailing Address - Fax:
Practice Address - Street 1:377 STATE RD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-7212
Practice Address - Country:US
Practice Address - Phone:508-693-7908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health