Healthcare Provider Details

I. General information

NPI: 1790399905
Provider Name (Legal Business Name): GHJR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

20 WOODSIDE AVE STE A
MIDDLEBURY CT
06762-2857
US

IV. Provider business mailing address

20 WOODSIDE AVE STE A
MIDDLEBURY CT
06762-2857
US

V. Phone/Fax

Practice location:
  • Phone: 203-464-0821
  • Fax:
Mailing address:
  • Phone: 203-721-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GEORGE HAYES
Title or Position: OWNER
Credential: LCSW
Phone: 203-464-0821