Provider Demographics
NPI:1144804808
Name:ASSUAGE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ASSUAGE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-550-0769
Mailing Address - Street 1:1 REGENCY DR STE 307
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2310
Mailing Address - Country:US
Mailing Address - Phone:860-550-0769
Mailing Address - Fax:
Practice Address - Street 1:1 REGENCY DR STE 307
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2310
Practice Address - Country:US
Practice Address - Phone:860-550-0769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty