Provider Demographics
NPI:1407250798
Name:CONNECTIONS A COUNSELING CENTER
Entity Type:Organization
Organization Name:CONNECTIONS A COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-543-6349
Mailing Address - Street 1:39055 HASTINGS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1518
Mailing Address - Country:US
Mailing Address - Phone:510-789-3368
Mailing Address - Fax:
Practice Address - Street 1:39055 HASTINGS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1518
Practice Address - Country:US
Practice Address - Phone:510-789-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty