Provider Demographics
NPI:1801666136
Name:WARRIOR HEART COUNSELING LLC
Entity type:Organization
Organization Name:WARRIOR HEART COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JENN
Authorized Official - Last Name:DEMELLO EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MED, LMHC
Authorized Official - Phone:774-644-1808
Mailing Address - Street 1:66 LODGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1314
Mailing Address - Country:US
Mailing Address - Phone:617-237-6371
Mailing Address - Fax:
Practice Address - Street 1:66 LODGEHILL RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1314
Practice Address - Country:US
Practice Address - Phone:774-644-1808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty