Healthcare Provider Details

I. General information

NPI: 1548112196
Provider Name (Legal Business Name): BRIDGET CLARK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ANN ST
FAIRFIELD CT
06824-5801
US

IV. Provider business mailing address

121 ANN ST
FAIRFIELD CT
06824-5801
US

V. Phone/Fax

Practice location:
  • Phone: 203-919-8677
  • Fax:
Mailing address:
  • Phone: 203-919-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET BLAKE CLARK
Title or Position: OWNER/MENTAL HEALTH COUNSELOR
Credential: LPC
Phone: 203-919-8677