Healthcare Provider Details

I. General information

NPI: 1649571639
Provider Name (Legal Business Name): COUNSELING SERVICES OF LITCHFIELD COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 03/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BIRGE PARK RD SUITE 2
HARWINTON CT
06791-1909
US

IV. Provider business mailing address

200 BIRGE PARK RD SUITE 2
HARWINTON CT
06791-1909
US

V. Phone/Fax

Practice location:
  • Phone: 860-309-7262
  • Fax: 860-485-9375
Mailing address:
  • Phone: 860-309-7262
  • Fax: 860-485-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000360
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00935
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number000935
License Number StateCT

VIII. Authorized Official

Name: REGINA WAYNE
Title or Position: OWNER
Credential: LPC
Phone: 860-309-7262