1386940500 NPI number — SUPPORTIVE COUNSELING SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386940500 NPI number — SUPPORTIVE COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPPORTIVE COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386940500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 KENSINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06040-5421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-305-6164
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
843 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06040-6020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-305-6164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MELQUIST
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-305-6164

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  001277 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001277 . This is a "CT LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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