Provider Demographics
NPI:1760827422
Name:JOURNEY TO HEALING CLINICAL SERVICES
Entity Type:Organization
Organization Name:JOURNEY TO HEALING CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLINDA
Authorized Official - Middle Name:KIZURI
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-794-8260
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:POQUONOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06064-0046
Mailing Address - Country:US
Mailing Address - Phone:860-794-8260
Mailing Address - Fax:
Practice Address - Street 1:3580 MAIN ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1121
Practice Address - Country:US
Practice Address - Phone:860-794-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0082591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008044968Medicaid