Provider Demographics
NPI:1407286081
Name:A BALANCED LIFE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:A BALANCED LIFE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-529-1696
Mailing Address - Street 1:415 SILAS DEANE HIGHWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2124
Mailing Address - Country:US
Mailing Address - Phone:860-529-1696
Mailing Address - Fax:860-529-1696
Practice Address - Street 1:415 SILAS DEANE HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2124
Practice Address - Country:US
Practice Address - Phone:860-529-1696
Practice Address - Fax:860-529-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty