Provider Demographics
NPI:1043567837
Name:MY FATHER MY SON REHABILITATION AND COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:MY FATHER MY SON REHABILITATION AND COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:BILL
Authorized Official - Last Name:OKWUOSA
Authorized Official - Suffix:
Authorized Official - Credentials:LADCCACATSA
Authorized Official - Phone:203-747-8689
Mailing Address - Street 1:264 AMITY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2200
Mailing Address - Country:US
Mailing Address - Phone:203-747-8689
Mailing Address - Fax:203-745-0493
Practice Address - Street 1:264 AMITY RD STE 104
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2200
Practice Address - Country:US
Practice Address - Phone:203-747-8689
Practice Address - Fax:203-745-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008041411Medicaid