Provider Demographics
NPI:1194558759
Name:HARBORSIDE COUNSELING AND WELLNESS LLC
Entity type:Organization
Organization Name:HARBORSIDE COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-406-4882
Mailing Address - Street 1:103 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6319
Mailing Address - Country:US
Mailing Address - Phone:757-406-4882
Mailing Address - Fax:
Practice Address - Street 1:103 OLIVER ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6319
Practice Address - Country:US
Practice Address - Phone:757-406-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty