Provider Demographics
NPI:1003529744
Name:PILLAR OF HOPE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:PILLAR OF HOPE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CEBALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-808-3543
Mailing Address - Street 1:9 UNION SQ UNIT 1088
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2204
Mailing Address - Country:US
Mailing Address - Phone:203-808-3543
Mailing Address - Fax:
Practice Address - Street 1:33 COURT ST STE 2
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2211
Practice Address - Country:US
Practice Address - Phone:203-808-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008110935Medicaid