Provider Demographics
NPI:1801148507
Name:PRIVATE COUNSELING ASSOCIATES LLC
Entity type:Organization
Organization Name:PRIVATE COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEADY
Authorized Official - Suffix:
Authorized Official - Credentials:CRC, LADC, LPC
Authorized Official - Phone:860-918-1782
Mailing Address - Street 1:122A NAUBUC AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4246
Mailing Address - Country:US
Mailing Address - Phone:860-918-1782
Mailing Address - Fax:
Practice Address - Street 1:122A NAUBUC AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4246
Practice Address - Country:US
Practice Address - Phone:860-918-1782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000966261QU0200X
CT002175261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care