Provider Demographics
NPI:1710362439
Name:SLMD, INC. DBA COUNSELING CONNECTIONS
Entity Type:Organization
Organization Name:SLMD, INC. DBA COUNSELING CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANCINI-DUBREY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:401-447-9913
Mailing Address - Street 1:504 MAIN ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1214
Mailing Address - Country:US
Mailing Address - Phone:774-272-5671
Mailing Address - Fax:774-568-5614
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1214
Practice Address - Country:US
Practice Address - Phone:774-272-5671
Practice Address - Fax:774-568-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1171641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty