Healthcare Provider Details

I. General information

NPI: 1942792403
Provider Name (Legal Business Name): INTEGRITY CARE AND COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MAIN ST
ELLINGTON CT
06029-3360
US

IV. Provider business mailing address

16 MAIN ST
ELLINGTON CT
06029-3360
US

V. Phone/Fax

Practice location:
  • Phone: 860-871-5402
  • Fax: 860-871-5413
Mailing address:
  • Phone: 860-871-5402
  • Fax: 860-871-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001186
License Number StateCT

VIII. Authorized Official

Name: MR. JOSEPH DAVID BOIVIN
Title or Position: PSYCHOTHERAPIST
Credential: LPC/LADC
Phone: 860-871-5402