| Providence Counseling, Llc | |
|
920 Providence Hwy Dedham MA 02026 | |
| (617) 987-4187 | |
| (617) 684-6374 |
| Full Name | Providence Counseling, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 920 Providence Hwy, Dedham, Massachusetts |
| Authorized Official Name and Position | Stanislav Sevostyanov (OWNER/THERAPIST) |
| Authorized Official Contact | 6179874187 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Counseling, Llc 920 Providence Hwy Dedham MA 02026-6809 Ph: (617) 987-4187 | Providence Counseling, Llc 920 Providence Hwy Dedham MA 02026 Ph: (617) 987-4187 |
| NPI Number | 1114717410 |
|---|---|
| Provider Enumeration Date | 05/09/2025 |
| Last Update Date | 05/15/2025 |
| Certification Date | 05/15/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114717410 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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