Provider Demographics
NPI:1346875689
Name:INDIGO COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:INDIGO COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-869-5034
Mailing Address - Street 1:96 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-4005
Mailing Address - Country:US
Mailing Address - Phone:860-869-5034
Mailing Address - Fax:
Practice Address - Street 1:360 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2700
Practice Address - Country:US
Practice Address - Phone:860-869-5034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty