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General NPI Number Information
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NPI Number | 1801176664
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Entity Type | Organization
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Legal Business Name | NORTHEND COMMUNITY COUNSELING CENTER
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 140 HUYSHOPE AVE 512
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City | HARTFORD
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State | CT
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Zip | 06106-2857
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Country | US
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Telephone | 860-280-5489
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Fax |
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Provider Business Mailing Address
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Address Line | 261 BARBOUR ST
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City | HARTFORD
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State | CT
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Zip | 06120-1705
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Country | US
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Telephone | 860-280-5489
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL A JONES
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Credential | MSW
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Telephone | 860-280-5489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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