Provider Demographics
NPI:1730799099
Name:T.R.U.E. SELF COUNSELING
Entity type:Organization
Organization Name:T.R.U.E. SELF COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-FANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-461-9209
Mailing Address - Street 1:48 BARRY CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1972
Mailing Address - Country:US
Mailing Address - Phone:860-461-9209
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST STE 1310
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2700
Practice Address - Country:US
Practice Address - Phone:860-461-9209
Practice Address - Fax:866-402-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008054865Medicaid