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General NPI Number Information
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NPI Number | 1073020574
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Entity Type | Organization
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Legal Business Name | AMC COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 100 PEARL STREET 14TH FLOOR
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City | HARTFORD
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State | CT
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Zip | 06103
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Country | US
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Telephone | 860-951-4130
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Fax | 844-236-0711
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Provider Business Mailing Address
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Address Line | 100 PEARL STREET 14TH FLOOR
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City | HARTFORD
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State | CT
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Zip | 06103
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Country | US
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Telephone | 860-951-4130
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Fax | 844-236-0711
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Authorized Official
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Title or Position | SOLE MEMBER/MANAGER
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Name | MRS. AIDA MARIE VAZQUEZ-CANIDATE
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Credential | LMFT
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Telephone | 860-816-2351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001949
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License Number State | CT
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