Provider Demographics
NPI:1073020574
Name:AMC COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:AMC COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VAZQUEZ-CANIDATE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-816-2351
Mailing Address - Street 1:100 PEARL STREET
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103
Mailing Address - Country:US
Mailing Address - Phone:860-951-4130
Mailing Address - Fax:844-236-0711
Practice Address - Street 1:100 PEARL STREET
Practice Address - Street 2:14TH FLOOR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103
Practice Address - Country:US
Practice Address - Phone:860-951-4130
Practice Address - Fax:844-236-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty