Provider Demographics
NPI:1396269205
Name:MINDFUL JOURNEY COUNSELING, LLC
Entity type:Organization
Organization Name:MINDFUL JOURNEY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYJEANNE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:CHICHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-302-5427
Mailing Address - Street 1:1686 FARMINGTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1279
Mailing Address - Country:US
Mailing Address - Phone:860-302-5427
Mailing Address - Fax:
Practice Address - Street 1:1686 FARMINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1279
Practice Address - Country:US
Practice Address - Phone:860-302-5427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0087521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty