Provider Demographics
NPI:1871979567
Name:SANKOFA COUNSELING LLC
Entity type:Organization
Organization Name:SANKOFA COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RESHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, MSW, ADS
Authorized Official - Phone:203-928-0807
Mailing Address - Street 1:P.O. BOX 3744
Mailing Address - Street 2:1449 WHALLEY AVENUE
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-9994
Mailing Address - Country:US
Mailing Address - Phone:203-928-0807
Mailing Address - Fax:
Practice Address - Street 1:64 THOMPSON ST STE A101
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-928-0807
Practice Address - Fax:203-889-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1142251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008060075Medicaid