Provider Demographics
NPI:1578151221
Name:THE WELL CHRISTIAN COUNSELING, LLC
Entity Type:Organization
Organization Name:THE WELL CHRISTIAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-802-1326
Mailing Address - Street 1:27 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3324
Mailing Address - Country:US
Mailing Address - Phone:203-802-1326
Mailing Address - Fax:
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2406
Practice Address - Country:US
Practice Address - Phone:203-802-1326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty