| Radiance Llc | |
|
33 Dover St Ste 313 Brockton MA 02301-5973 | |
| (774) 494-2135 | |
| (339) 444-2717 |
| Full Name | Radiance Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 33 Dover St Ste 313, Brockton, Massachusetts |
| Authorized Official Name and Position | Debroah Ford (OWNER) |
| Authorized Official Contact | 7744942135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiance Llc 33 Dover St Ste 313 Brockton MA 02301-5973 Ph: (774) 494-2135 | Radiance Llc 33 Dover St Ste 313 Brockton MA 02301-5973 Ph: (774) 494-2135 |
| NPI Number | 1851157309 |
|---|---|
| Provider Enumeration Date | 02/22/2024 |
| Last Update Date | 02/22/2024 |
| Certification Date | 02/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851157309 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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