Provider Demographics
NPI:1659914331
Name:HEART CENTERED COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:HEART CENTERED COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-920-2193
Mailing Address - Street 1:25 CHRISTMAS TREE HL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2127
Mailing Address - Country:US
Mailing Address - Phone:860-920-2193
Mailing Address - Fax:
Practice Address - Street 1:674 PROSPECT AVE STE 206
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4288
Practice Address - Country:US
Practice Address - Phone:860-920-2193
Practice Address - Fax:860-578-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008086088Medicaid