Provider Demographics
NPI:1679220891
Name:TURNING OVER A NEW LEAF OF PEACE LLC
Entity type:Organization
Organization Name:TURNING OVER A NEW LEAF OF PEACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-295-0901
Mailing Address - Street 1:43 CONGRESS ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-4070
Mailing Address - Country:US
Mailing Address - Phone:570-295-0901
Mailing Address - Fax:
Practice Address - Street 1:43 CONGRESS ST APT 1A
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-4070
Practice Address - Country:US
Practice Address - Phone:570-295-0901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty