Healthcare Provider Details

I. General information

NPI: 1801148507
Provider Name (Legal Business Name): PRIVATE COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122A NAUBUC AVE SUITE 210
GLASTONBURY CT
06033-4246
US

IV. Provider business mailing address

122A NAUBUC AVE SUITE 210
GLASTONBURY CT
06033-4246
US

V. Phone/Fax

Practice location:
  • Phone: 860-918-1782
  • Fax:
Mailing address:
  • Phone: 860-918-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number002175
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number000966
License Number StateCT

VIII. Authorized Official

Name: MR. MICHAEL E STEADY
Title or Position: PRESIDENT
Credential: CRC, LADC, LPC
Phone: 860-918-1782