Provider Demographics
NPI:1912026253
Name:COLCHESTER CENTER FOR COUNSELING LLC
Entity Type:Organization
Organization Name:COLCHESTER CENTER FOR COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE AND FAMILY THERAP
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:DESILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MAMFT
Authorized Official - Phone:860-537-6656
Mailing Address - Street 1:63 HAYWARD AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1221
Mailing Address - Country:US
Mailing Address - Phone:860-537-6656
Mailing Address - Fax:860-228-0669
Practice Address - Street 1:63 HAYWARD AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1221
Practice Address - Country:US
Practice Address - Phone:860-537-6656
Practice Address - Fax:860-228-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000989101YP2500X
CT000822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty