Provider Demographics
NPI:1609131903
Name:SALLY SACKS AND ASSOCIATES COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:SALLY SACKS AND ASSOCIATES COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SACKS
Authorized Official - Suffix:
Authorized Official - Credentials:MED LMHC
Authorized Official - Phone:978-692-6900
Mailing Address - Street 1:29 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-692-6900
Mailing Address - Fax:978-635-0270
Practice Address - Street 1:234 LITTLETON RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886
Practice Address - Country:US
Practice Address - Phone:978-692-6900
Practice Address - Fax:978-635-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)