Provider Demographics
NPI:1083457634
Name:WELLNESS JOURNEY COUNSELING
Entity type:Organization
Organization Name:WELLNESS JOURNEY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:978-875-0710
Mailing Address - Street 1:40 MECHANIC ST STE 307
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4425
Mailing Address - Country:US
Mailing Address - Phone:508-426-8440
Mailing Address - Fax:
Practice Address - Street 1:40 MECHANIC ST STE 307
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4425
Practice Address - Country:US
Practice Address - Phone:508-426-8440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)