Basic Information
| Provider Information | |||||||||
| NPI: | 1912637612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEDGES | ||||||||
| FirstName: | ASIA | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 WATERSIDE XING STE 401 | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060951588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606973351 | ||||||||
| FaxNumber: | 8607315536 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062261910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604567200 | ||||||||
| FaxNumber: | 8607315536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2022 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.