Healthcare Provider Details

I. General information

NPI: 1942945415
Provider Name (Legal Business Name): HOPEFUL HEARTS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HIGH ST
SUFFIELD CT
06078-2125
US

IV. Provider business mailing address

46 PERSHING RD
WINDSOR LOCKS CT
06096-2123
US

V. Phone/Fax

Practice location:
  • Phone: 860-916-8066
  • Fax:
Mailing address:
  • Phone: 860-916-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MIKAL LARSEN
Title or Position: PROVIDER
Credential: LCSW
Phone: 860-916-8066