Organization
INTENTIONAL SELF. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA C RANGE LMHC (OWNER)
(781) 767-0008
Entity
Organization
Contact information
Practice address
6 CABOT PL, SUITE # 6, STOUGHTON, MA 02072-4625
(781) 767-0008
Mailing address
141 MEMORIAL PKWY, PMB 211, RANDOLPH, MA 02368-4511
(781) 767-0008
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
5509
MA
Other
Enumeration date
01/02/2014
Last updated
01/02/2014
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