Provider Demographics
NPI:1568780963
Name:AVILA, RAUL A (LPC)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:A
Last Name:AVILA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CONNOLLY PKWY
Mailing Address - Street 2:BUILDING 2 ROOM 1-109
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2593
Mailing Address - Country:US
Mailing Address - Phone:203-281-0300
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PKWY BLDG 2B SUITE 1-109
Practice Address - Street 2:ALTERNATIVE THERAPY, LLC
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-281-0300
Practice Address - Fax:203-248-5312
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional