Provider Demographics
NPI:1245936186
Name:COUNSELING & CONNECTIONS
Entity type:Organization
Organization Name:COUNSELING & CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JAEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-652-0464
Mailing Address - Street 1:757 GALLIVAN BLVD. SUITE 1 - 1077
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:757 GALLIVAN BLVD. SUITE 1 - 1077
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-652-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)