| The Center For Healing Indigo Wisdom Professional Counseling Llc | |
|
17 Mathewson St Jewett City CT 06351-2213 | |
| (860) 204-2933 | |
| Not Available |
| Full Name | The Center For Healing Indigo Wisdom Professional Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 17 Mathewson St, Jewett City, Connecticut |
| Authorized Official Name and Position | Donna A Johnston (OWNER/LCSW) |
| Authorized Official Contact | 8602042933 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Center For Healing Indigo Wisdom Professional Counseling Llc 42 Beechwood Blvd Plainfield CT 06374-2101 Ph: (860) 204-2933 | The Center For Healing Indigo Wisdom Professional Counseling Llc 17 Mathewson St Jewett City CT 06351-2213 Ph: (860) 204-2933 |
| NPI Number | 1588121099 |
|---|---|
| Provider Enumeration Date | 02/21/2019 |
| Last Update Date | 02/22/2019 |
| Medicare PECOS PAC ID | 6406198647 |
|---|---|
| Medicare Enrollment ID | O20190508002106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588121099 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Donna Alice Johnston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780920215 PECOS PAC ID: 6103118625 Enrollment ID: I20160701000805 |
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