Provider Demographics
NPI:1184096067
Name:GRAFTON WELLNESS COUNSELING, LLC
Entity type:Organization
Organization Name:GRAFTON WELLNESS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TISIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIESLUK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:774-293-4474
Mailing Address - Street 1:210 WORCESTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1289
Mailing Address - Country:US
Mailing Address - Phone:774-293-4474
Mailing Address - Fax:
Practice Address - Street 1:210 WORCESTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1289
Practice Address - Country:US
Practice Address - Phone:774-293-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty