Provider Demographics
NPI:1699497131
Name:COMMUNITY COUNSELING CENTER PLLC
Entity type:Organization
Organization Name:COMMUNITY COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OSEI
Authorized Official - Last Name:BOADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-365-5228
Mailing Address - Street 1:415 BOSTON TPKE STE 201
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3414
Mailing Address - Country:US
Mailing Address - Phone:508-365-5228
Mailing Address - Fax:
Practice Address - Street 1:415 BOSTON TPKE STE 201
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3414
Practice Address - Country:US
Practice Address - Phone:508-365-5228
Practice Address - Fax:508-213-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty