Organization
EASTERN SERVICES & CAMP SIMON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALY PHIMVONGSA LPC, NCC (DIRECTOR)
(860) 254-5127
Entity
Organization
Contact information
Practice address
115 BRIDGE ST, SUITE C, EAST WINDSOR, CT 06088-9547
(860) 254-5127
(860) 254-5254
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
101YP2500X
Professional Counselor
Primary
001470
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004257053
—
CT
Enumeration date
11/29/2011
Last updated
02/11/2020
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