Provider Demographics
NPI:1467911990
Name:TLJ, INC.
Entity Type:Organization
Organization Name:TLJ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-982-4755
Mailing Address - Street 1:22 ONYX DR
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3521
Mailing Address - Country:US
Mailing Address - Phone:508-982-4755
Mailing Address - Fax:877-308-2202
Practice Address - Street 1:25W OLD WESTPORT RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2513
Practice Address - Country:US
Practice Address - Phone:508-982-4755
Practice Address - Fax:877-308-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty