| Kettavong Counseling, Llc | |
|
18 Oneco St Suite 3 Norwich CT 06360-3440 | |
| (860) 822-3208 | |
| Not Available |
| Full Name | Kettavong Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 18 Oneco St, Norwich, Connecticut |
| Authorized Official Name and Position | Malyna Kettavong (OWNER) |
| Authorized Official Contact | 8608039724 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kettavong Counseling, Llc 18 Oneco St Suite 3 Norwich CT 06360-3440 Ph: () - | Kettavong Counseling, Llc 18 Oneco St Suite 3 Norwich CT 06360-3440 Ph: (860) 822-3208 |
| NPI Number | 1285084517 |
|---|---|
| Provider Enumeration Date | 06/17/2016 |
| Last Update Date | 08/14/2017 |
| Medicare PECOS PAC ID | 9032407960 |
|---|---|
| Medicare Enrollment ID | O20161010001440 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285084517 | NPI | - | NPPES |
| Provider Name | Malyna Kettavong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922435676 PECOS PAC ID: 0840511366 Enrollment ID: I20150609000524 |
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