Provider Demographics
NPI:1184078966
Name:TRUECHANCE
Entity type:Organization
Organization Name:TRUECHANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-550-4595
Mailing Address - Street 1:39 NEW LONDON TPKE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2061
Mailing Address - Country:US
Mailing Address - Phone:860-550-4595
Mailing Address - Fax:860-812-2061
Practice Address - Street 1:39 NEW LONDON TPKE
Practice Address - Street 2:SUITE 320
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2061
Practice Address - Country:US
Practice Address - Phone:860-550-4595
Practice Address - Fax:860-812-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty