Provider Demographics
NPI:1558137349
Name:PROFESSIONAL SUPPORTIVE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL SUPPORTIVE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:B-MULLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:860-324-0808
Mailing Address - Street 1:368 OCONNELL DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-3445
Mailing Address - Country:US
Mailing Address - Phone:186-324-0808
Mailing Address - Fax:860-569-7015
Practice Address - Street 1:360 BLOOMFIELD AVE STE 301
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2700
Practice Address - Country:US
Practice Address - Phone:186-607-3285
Practice Address - Fax:860-569-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty