Provider Demographics
NPI:1578165460
Name:SIDE QUEST COUNSELING LLC
Entity Type:Organization
Organization Name:SIDE QUEST COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-290-1661
Mailing Address - Street 1:410 STATE ST STE 16
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3148
Mailing Address - Country:US
Mailing Address - Phone:203-290-1661
Mailing Address - Fax:
Practice Address - Street 1:410 STATE ST STE 16
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3148
Practice Address - Country:US
Practice Address - Phone:203-290-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty