Provider Demographics
NPI:1922043447
Name:WILMINGTON FAMILY COUNSELING SERVICE INC
Entity Type:Organization
Organization Name:WILMINGTON FAMILY COUNSELING SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-658-9889
Mailing Address - Street 1:5 MIDDLESEX AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887
Mailing Address - Country:US
Mailing Address - Phone:978-658-9889
Mailing Address - Fax:978-658-5695
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:SUITE 11 WILMINGTON FAMILY COUNSELING SERVICE INC
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887
Practice Address - Country:US
Practice Address - Phone:978-658-9889
Practice Address - Fax:978-658-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20364Medicare ID - Type Unspecified