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General NPI Number Information
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NPI Number | 1730799099
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Entity Type | Organization
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Legal Business Name | T.R.U.E. SELF COUNSELING
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 642 HILLIARD ST STE 1310
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City | MANCHESTER
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State | CT
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Zip | 06042-2700
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Country | US
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Telephone | 860-461-9209
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Fax | 866-402-8266
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Provider Business Mailing Address
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Address Line | 48 BARRY CIR
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City | BLOOMFIELD
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State | CT
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Zip | 06002-1972
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Country | US
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Telephone | 860-461-9209
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Fax |
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Authorized Official
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Title or Position | CLINICIAN/OWNER
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Name | NICOLE WILSON-FANIEL
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Credential | LCSW
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Telephone | 860-461-9209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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