Provider Demographics
NPI:1083178289
Name:ARROW OF CHANGE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:ARROW OF CHANGE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:UNDERHILL
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, MSW
Authorized Official - Phone:475-422-4361
Mailing Address - Street 1:5 BAYVIEW PL FL 1
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4702
Mailing Address - Country:US
Mailing Address - Phone:475-422-4361
Mailing Address - Fax:
Practice Address - Street 1:5 BAYVIEW PL FL 1
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4702
Practice Address - Country:US
Practice Address - Phone:475-422-4361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty