Provider Demographics
NPI:1437720745
Name:LIVE IN TRUTH THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:LIVE IN TRUTH THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-840-7390
Mailing Address - Street 1:1224 MILL ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-1159
Mailing Address - Country:US
Mailing Address - Phone:860-840-7390
Mailing Address - Fax:
Practice Address - Street 1:1224 MILL ST BLDG B
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1159
Practice Address - Country:US
Practice Address - Phone:860-840-7390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health