Provider Demographics
NPI:1619563236
Name:ALCON COUNSELING & WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:ALCON COUNSELING & WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ORQUIDEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS-JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-989-6726
Mailing Address - Street 1:1209 HORIZON WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-7106
Mailing Address - Country:US
Mailing Address - Phone:860-989-6726
Mailing Address - Fax:
Practice Address - Street 1:1209 HORIZON WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-7106
Practice Address - Country:US
Practice Address - Phone:860-989-6726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty