Provider Demographics
NPI:1790956365
Name:SOUTHEAST COUNSELING ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:SOUTHEAST COUNSELING ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-599-2125
Mailing Address - Street 1:185 S BROAD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1997
Mailing Address - Country:US
Mailing Address - Phone:860-599-2125
Mailing Address - Fax:401-322-0883
Practice Address - Street 1:185 S BROAD ST STE 103
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1997
Practice Address - Country:US
Practice Address - Phone:860-599-2125
Practice Address - Fax:401-322-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000880261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)