Provider Demographics
NPI:1326550104
Name:ASSURED PEACEFUL SOLUTIONS COUNSELING LLC
Entity Type:Organization
Organization Name:ASSURED PEACEFUL SOLUTIONS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAJAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS-PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-759-5097
Mailing Address - Street 1:990 MIGEON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4555
Mailing Address - Country:US
Mailing Address - Phone:203-819-0789
Mailing Address - Fax:
Practice Address - Street 1:1080 ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1844
Practice Address - Country:US
Practice Address - Phone:860-750-5097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty