Healthcare Provider Details

I. General information

NPI: 1013364942
Provider Name (Legal Business Name): THE ENLIGHTENMENT COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 PROSPECT AVE 2ND FLOOR
HARTFORD CT
06105-4230
US

IV. Provider business mailing address

998 FARMINGTON AVE SUITE 207
WEST HARTFORD CT
06107-2162
US

V. Phone/Fax

Practice location:
  • Phone: 860-729-6138
  • Fax: 860-519-5723
Mailing address:
  • Phone: 860-729-6138
  • Fax: 860-519-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7673
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNY ALZATE
Title or Position: CO-OWNER
Credential:
Phone: 860-729-6138