Provider Demographics
NPI:1780256677
Name:CORE PSYCHOTHERAPY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:CORE PSYCHOTHERAPY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ALECIA
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-532-8222
Mailing Address - Street 1:281 BURGUNDY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-6372
Mailing Address - Country:US
Mailing Address - Phone:860-532-8222
Mailing Address - Fax:
Practice Address - Street 1:281 BURGUNDY HILL LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-6372
Practice Address - Country:US
Practice Address - Phone:860-532-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health