Provider Demographics
NPI:1477191435
Name:REIMAGINE COUNSELING LLC
Entity Type:Organization
Organization Name:REIMAGINE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-302-7579
Mailing Address - Street 1:1245 HANCOCK ST STE 12
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4365
Mailing Address - Country:US
Mailing Address - Phone:617-302-7579
Mailing Address - Fax:
Practice Address - Street 1:1245 HANCOCK ST STE 12
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4365
Practice Address - Country:US
Practice Address - Phone:617-302-7579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty