Provider Demographics
NPI:1376803239
Name:PACES COUNSELING ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PACES COUNSELING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:860-528-3238
Mailing Address - Street 1:991 MAIN ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2274
Mailing Address - Country:US
Mailing Address - Phone:860-528-3238
Mailing Address - Fax:860-218-2489
Practice Address - Street 1:991 MAIN ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2274
Practice Address - Country:US
Practice Address - Phone:860-528-3238
Practice Address - Fax:860-218-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA-0149251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health