Organization
TEENS AGAINST GANG VIOLENCE
Active
Other names
TEENS ADVOCATING A GLOBAL VISION
Organization subpart
No
Provider details
NPI number
Authorized official
ULRIC R JOHNSON LMHC, LMFT, LADCI RC (OWNER)
61733650637
Entity
Organization
Contact information
Practice address
735 MORRISSEY BLVD, BOSTON, MA 02122-3406
(617) 365-0637
(617) 282-9659
Mailing address
2 MOODY ST, BOSTON, MA 02124-3507
(617) 365-0637
(617) 282-9659
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
40
MA
101YM0800X
Mental Health Counselor
265
MA
106H00000X
Marriage & Family Therapist
149
MA
Other
Enumeration date
12/30/2012
Last updated
02/16/2015
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