Organization
BREAKWATER COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTINA MICHELLE SIMON LICSW (MENTAL HEALTH CLINICIAN)
(508) 284-2121
Entity
Organization
Contact information
Practice address
2 MAIN ST FL 3, GLOUCESTER, MA 01930-5726
(508) 284-2121
Mailing address
30 MARBLE ST, GLOUCESTER, MA 01930-4281
(508) 284-2121
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/18/2021
Last updated
02/18/2021
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