Provider Demographics
NPI:1245467398
Name:SAFE HARBOR CHRISTIAN COUNSELING OF CONNECTICUT, LLC
Entity type:Organization
Organization Name:SAFE HARBOR CHRISTIAN COUNSELING OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:203-993-3555
Mailing Address - Street 1:55 CUTSPRING CIR
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1954
Mailing Address - Country:US
Mailing Address - Phone:203-993-3555
Mailing Address - Fax:
Practice Address - Street 1:498 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4855
Practice Address - Country:US
Practice Address - Phone:800-305-2089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001718251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health