Provider Demographics
NPI:1346561354
Name:NEW LIFE COUNSELING
Entity Type:Organization
Organization Name:NEW LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVELSON-CHRYSOSTOME
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-986-4800
Mailing Address - Street 1:9 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2424
Mailing Address - Country:US
Mailing Address - Phone:781-986-4800
Mailing Address - Fax:
Practice Address - Street 1:9 CANTON ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2424
Practice Address - Country:US
Practice Address - Phone:781-986-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILTON AND SOUTH SHORE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021505251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health