Provider Demographics
NPI:1407607534
Name:SECOND WAVE COUNSELING LLC
Entity Type:Organization
Organization Name:SECOND WAVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:774-260-5688
Mailing Address - Street 1:1 TAUNTON GRN STE 1
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3225
Mailing Address - Country:US
Mailing Address - Phone:774-260-5688
Mailing Address - Fax:
Practice Address - Street 1:1 TAUNTON GRN STE 1
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3225
Practice Address - Country:US
Practice Address - Phone:774-260-5688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty