Provider Demographics
NPI:1982076014
Name:COASTAL CONNECTICUT COUNSELING LLC
Entity Type:Organization
Organization Name:COASTAL CONNECTICUT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLESAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-307-3030
Mailing Address - Street 1:49 JOHN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1484
Mailing Address - Country:US
Mailing Address - Phone:203-307-3030
Mailing Address - Fax:203-255-7486
Practice Address - Street 1:49 JOHN ST STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1484
Practice Address - Country:US
Practice Address - Phone:203-307-3030
Practice Address - Fax:203-255-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty