Provider Demographics
NPI:1306038898
Name:COMMUNITY COUNSELING OF BRISTOL
Entity type:Organization
Organization Name:COMMUNITY COUNSELING OF BRISTOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GUYETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:508-828-9116
Mailing Address - Street 1:311 GREENWICH AVE APT D115
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-9701
Mailing Address - Country:US
Mailing Address - Phone:401-739-3680
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-828-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health