Provider Demographics
NPI:1760650519
Name:COUNSELING AFFILIATES LLC
Entity Type:Organization
Organization Name:COUNSELING AFFILIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:THAW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-659-2697
Mailing Address - Street 1:300 HEBRON AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2176
Mailing Address - Country:US
Mailing Address - Phone:860-659-2697
Mailing Address - Fax:860-659-3468
Practice Address - Street 1:300 HEBRON AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2176
Practice Address - Country:US
Practice Address - Phone:860-659-2697
Practice Address - Fax:860-659-3468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty