Provider Demographics
NPI:1609388875
Name:TRINITY ONE COUNSELING CENTER
Entity Type:Organization
Organization Name:TRINITY ONE COUNSELING CENTER
Other - Org Name:PATRICIA JENKINS-SIMMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, FOUNDER, COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JENKINS-SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MIN
Authorized Official - Phone:475-999-4004
Mailing Address - Street 1:410 STATE ST RM 3
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3149
Mailing Address - Country:US
Mailing Address - Phone:475-999-4004
Mailing Address - Fax:
Practice Address - Street 1:410 STATE ST RM 3
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3149
Practice Address - Country:US
Practice Address - Phone:475-999-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty