Provider Demographics
NPI:1548734791
Name:FARMINGTON VALLEY COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:FARMINGTON VALLEY COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-255-4017
Mailing Address - Street 1:111 SIMSBURY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3763
Mailing Address - Country:US
Mailing Address - Phone:860-255-4017
Mailing Address - Fax:
Practice Address - Street 1:111 SIMSBURY RD STE 104
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3763
Practice Address - Country:US
Practice Address - Phone:860-255-4017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty