Organization
ANCHORED SOUL COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE MAHON LCSW (OWNER)
(203) 980-7454
Entity
Organization
Contact information
Practice address
262 STATE ST STE C, NORTH HAVEN, CT 06473-2273
(203) 980-7454
Mailing address
262 STATE ST STE C, NORTH HAVEN, CT 06473-2273
(203) 980-7454
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457949117
—
CT
05
—
1841774254
—
CT
Enumeration date
12/17/2019
Last updated
05/03/2021
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