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Organization
EASTERN SERVICES & CAMP SIMON LLC
Active
Organization
EASTERN SERVICES & CAMP SIMON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALY PHIMVONGSA (CLINICAL DIRECTOR/OWNER)
(860) 254-5127
Entity
Organization
Contact information
Practice address
82 MAIN ST, WINDSOR LOCKS, CT 06096-2325
(860) 254-5127
(860) 310-4235
Mailing address
115 BRIDGE ST, SUITE C, EAST WINDSOR, CT 06088-9547
(860) 254-5127
(860) 254-5254
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
001470
CT
101YP2500X
Professional Counselor
002227
CT
Other
Enumeration date
01/24/2014
Last updated
02/11/2020
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