Provider Demographics
NPI:1396489092
Name:MOSSY STONE COUNSELING & WELLNESS, LLC
Entity type:Organization
Organization Name:MOSSY STONE COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMHC
Authorized Official - Prefix:
Authorized Official - First Name:SARINA
Authorized Official - Middle Name:FRANCESCA
Authorized Official - Last Name:VAN ZYL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-663-4607
Mailing Address - Street 1:70 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 STEVENS DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1239
Practice Address - Country:US
Practice Address - Phone:310-663-4607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty