Provider Demographics
NPI:1649939117
Name:CONNECTICUT COUNSELING CENTER LLC
Entity type:Organization
Organization Name:CONNECTICUT COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEDZIOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-397-6010
Mailing Address - Street 1:408 HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:408 HIGHLAND AVENUE
Practice Address - Street 2:BUILDING A SUITE 1
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1234
Practice Address - Country:US
Practice Address - Phone:203-397-6010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty