Provider Demographics
NPI:1639648017
Name:STILL WATERS COUNSELING SERVICES
Entity Type:Organization
Organization Name:STILL WATERS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ONORIO
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DADAMO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LADC LPC
Authorized Official - Phone:860-733-2803
Mailing Address - Street 1:110 NEW HAVEN AVENUE
Mailing Address - Street 2:115
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:860-733-2803
Mailing Address - Fax:
Practice Address - Street 1:57 PLAINS RD STE 1A
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2573
Practice Address - Country:US
Practice Address - Phone:860-733-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty