Provider Demographics
NPI:1710303110
Name:SENIOR CARE COUNSELING CONNECTION LLC
Entity Type:Organization
Organization Name:SENIOR CARE COUNSELING CONNECTION LLC
Other - Org Name:SENIOR CARE COUNSELING CONNECTION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCQUIGG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:317-653-4249
Mailing Address - Street 1:8103 E US HIGHWAY 36
Mailing Address - Street 2:158
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7964
Mailing Address - Country:US
Mailing Address - Phone:317-653-4249
Mailing Address - Fax:
Practice Address - Street 1:8103 E US HIGHWAY 36
Practice Address - Street 2:158
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7964
Practice Address - Country:US
Practice Address - Phone:317-653-4249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006693A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health