Organization Name: | SOUTHEAST COUNSELING ASSOCIATES, LTD. |
NPI Number: | 1790956365 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HERBERT NIEBURG (PRESIDENT) |
Mailing Address: | 185 S Broad St Ste 103 Pawcatuck |
State: | CT US |
Postal Code: | 063791997 |
Phone Number: | 8605992125 |
Fax Number: | 4013220883 |
NPI Enumeration Date: | 03/21/2008 |
NPI Last Update Date: | 03/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | 000880 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |