Healthcare Provider Details

I. General information

NPI: 1194219451
Provider Name (Legal Business Name): DEEPER VIEW COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 MEADOW ST STE 402
WATERBURY CT
06702-1807
US

IV. Provider business mailing address

245 COLONIAL AVE APT 4A
WATERBURY CT
06704-1359
US

V. Phone/Fax

Practice location:
  • Phone: 203-754-1551
  • Fax:
Mailing address:
  • Phone: 203-332-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003271
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number003271
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number003271
License Number StateCT

VIII. Authorized Official

Name: MR. SOLOMON YAW DARKO
Title or Position: THERAPIST/OWNER
Credential: LPC, MBA, MS
Phone: 203-332-1313