Provider Demographics
NPI:1093451148
Name:PROCARE COUNSELING CT, LLC
Entity Type:Organization
Organization Name:PROCARE COUNSELING CT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LADC
Authorized Official - Prefix:
Authorized Official - First Name:NATACHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:203-490-8539
Mailing Address - Street 1:27 ACTON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-1802
Mailing Address - Country:US
Mailing Address - Phone:203-490-8539
Mailing Address - Fax:
Practice Address - Street 1:27 ACTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1802
Practice Address - Country:US
Practice Address - Phone:203-490-8539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty