Provider Demographics
NPI:1023894797
Name:PHASES COUNSELING AND MEDIATION CENTER LLC
Entity type:Organization
Organization Name:PHASES COUNSELING AND MEDIATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:401-424-1364
Mailing Address - Street 1:70 HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1545
Mailing Address - Country:US
Mailing Address - Phone:973-809-8253
Mailing Address - Fax:
Practice Address - Street 1:70 HOOD AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1545
Practice Address - Country:US
Practice Address - Phone:973-809-8253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHASES COUNSELING AND MEDIATION CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty