Healthcare Provider Details

I. General information

NPI: 1699392431
Provider Name (Legal Business Name): FAIRFIELD COUNSELING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 POST RD STE 2
FAIRFIELD CT
06824-6246
US

IV. Provider business mailing address

1468 BURR ST
FAIRFIELD CT
06824-1892
US

V. Phone/Fax

Practice location:
  • Phone: 203-581-0053
  • Fax:
Mailing address:
  • Phone: 203-581-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KARINA ANDRE
Title or Position: OWNER
Credential: LPC LADC
Phone: 203-581-0053