Provider Demographics
NPI:1255479531
Name:COUNSELING COLLABORATIVE
Entity Type:Organization
Organization Name:COUNSELING COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER COUNSELING COLLABORATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-861-1818
Mailing Address - Street 1:57 BEDFORD ST
Mailing Address - Street 2:#125
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420
Mailing Address - Country:US
Mailing Address - Phone:781-861-1818
Mailing Address - Fax:781-861-2057
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:#125
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420
Practice Address - Country:US
Practice Address - Phone:781-861-1818
Practice Address - Fax:781-861-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty