Organization
ACTUALIZE COUNSELING & NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KEOVONGSA RD, LDN (OWNER)
(781) 430-9833
Entity
Organization
Contact information
Practice address
30 STANDISH RD, ARLINGTON, MA 02476-7069
(781) 430-9833
Mailing address
30 STANDISH RD, ARLINGTON, MA 02476-7069
(781) 430-9833
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
Other
Enumeration date
03/02/2020
Last updated
09/25/2023
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