Provider Demographics
NPI:1518533967
Name:ACTIVE BALANCED COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:ACTIVE BALANCED COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-633-2918
Mailing Address - Street 1:266 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1213
Mailing Address - Country:US
Mailing Address - Phone:617-633-2918
Mailing Address - Fax:
Practice Address - Street 1:266 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1213
Practice Address - Country:US
Practice Address - Phone:617-633-2918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)