Provider Demographics
NPI:1164646444
Name:PARK PLACE COUNSELING INC.
Entity Type:Organization
Organization Name:PARK PLACE COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-664-4228
Mailing Address - Street 1:352 PARK ST
Mailing Address - Street 2:SUITE 207 WEST
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:352 PARK ST
Practice Address - Street 2:SUITE 207 WEST
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2164
Practice Address - Country:US
Practice Address - Phone:978-664-4228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79434191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06072Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER