Healthcare Provider Details

I. General information

NPI: 1497016885
Provider Name (Legal Business Name): COUNSELING CENTER FOR WOMEN AND CHILDREN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2012
Last Update Date: 06/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 MILL ST BUILDING B, SUITE 103
EAST BERLIN CT
06023-1159
US

IV. Provider business mailing address

25 LORI LN
MERIDEN CT
06450-3574
US

V. Phone/Fax

Practice location:
  • Phone: 860-575-4144
  • Fax:
Mailing address:
  • Phone: 203-715-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002119
License Number StateCT

VIII. Authorized Official

Name: REBECCA CARR
Title or Position: OWNER
Credential: LPC
Phone: 860-575-4144