Provider Demographics
NPI:1730580382
Name:GREATER HARTFORD COUNSELING AND WELLNESS CENTER
Entity type:Organization
Organization Name:GREATER HARTFORD COUNSELING AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:8603-106-8192
Mailing Address - Street 1:140 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1737
Mailing Address - Country:US
Mailing Address - Phone:860-306-8192
Mailing Address - Fax:
Practice Address - Street 1:1019 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3955
Practice Address - Country:US
Practice Address - Phone:860-306-8192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0086531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty