Provider Demographics
NPI:1093406951
Name:AUTHENTIC CONNECTIONS COUNSELING
Entity Type:Organization
Organization Name:AUTHENTIC CONNECTIONS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KISS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-494-2357
Mailing Address - Street 1:455 SEA ST UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-2704
Mailing Address - Country:US
Mailing Address - Phone:508-494-2357
Mailing Address - Fax:
Practice Address - Street 1:455 SEA ST UNIT 1B
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-2704
Practice Address - Country:US
Practice Address - Phone:508-494-2357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty