Provider Demographics
NPI:1043970387
Name:HOLISTIC BEHAVIORAL HEALTH OF CONNECTICUT LLC
Entity Type:Organization
Organization Name:HOLISTIC BEHAVIORAL HEALTH OF CONNECTICUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OKECHUKWU
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHIDIADI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:608-695-0308
Mailing Address - Street 1:116 COTTAGE GROVE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3200
Mailing Address - Country:US
Mailing Address - Phone:860-869-5030
Mailing Address - Fax:
Practice Address - Street 1:116 COTTAGE GROVE RD STE 110
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3200
Practice Address - Country:US
Practice Address - Phone:860-904-5433
Practice Address - Fax:860-904-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty