Provider Demographics
NPI:1598409955
Name:HARBORSIDE COUNSELING AND MEDIATION LLC
Entity Type:Organization
Organization Name:HARBORSIDE COUNSELING AND MEDIATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CTP
Authorized Official - Phone:574-274-7358
Mailing Address - Street 1:1400 E ANGELA BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1364
Mailing Address - Country:US
Mailing Address - Phone:574-212-2494
Mailing Address - Fax:
Practice Address - Street 1:1400 E ANGELA BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1364
Practice Address - Country:US
Practice Address - Phone:574-212-2494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty