Provider Demographics
NPI:1740958321
Name:EYE EXPLORE YOUR ESSENCE LLC
Entity type:Organization
Organization Name:EYE EXPLORE YOUR ESSENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:DAZJAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-259-4434
Mailing Address - Street 1:99 LANTERN PARK DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1840
Mailing Address - Country:US
Mailing Address - Phone:860-259-4434
Mailing Address - Fax:
Practice Address - Street 1:99 LANTERN PARK DR UNIT 4
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-1840
Practice Address - Country:US
Practice Address - Phone:860-259-4434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty