Healthcare Provider Details

I. General information

NPI: 1467929554
Provider Name (Legal Business Name): CONNECTIONS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2018
Last Update Date: 10/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17150 MCERLAIN ST
SOUTH BEND IN
46635-1756
US

IV. Provider business mailing address

17150 MCERLAIN ST
SOUTH BEND IN
46635-1756
US

V. Phone/Fax

Practice location:
  • Phone: 574-250-2748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: APRIL KWIATKOWSKI
Title or Position: MANAGING MEMBER
Credential: MSW, LCSW
Phone: 574-250-2748