Authentic Wellness Therapy LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Northborough, MA. Organization (NPI-2).
NPI number1073152153
StatusActive
Last updated in NPPESJan 6, 2020
Details
- NPI
- 1073152153
- Entity type
- Organization (NPI-2)
- Legal business name
- Authentic Wellness Therapy LLC
- Organization subpart
- No
- Enumeration date
- Jan 6, 2020
- Certification date
- Jan 6, 2020
- Last updated
- Jan 6, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
Authentic Wellness Therapy LLC300 West Main Street, Building B
Northborough, MA 01532
Phone 508-471-6410
Mailing address
Po Box 2Sterling, MA 01564-0002
Phone 508-471-6410
Authorized official
Jillian Garofano-Staines
Clinician/Owner
5084716410
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