Healthcare Provider Details

I. General information

NPI: 1093062853
Provider Name (Legal Business Name): STOKES COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2012
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 PORTER AVE SUITE 2A
NAUGATUCK CT
06770-1973
US

IV. Provider business mailing address

35 PORTER AVE SUITE 2A
NAUGATUCK CT
06770-1973
US

V. Phone/Fax

Practice location:
  • Phone: 203-572-2962
  • Fax: 203-723-0702
Mailing address:
  • Phone: 203-572-2962
  • Fax: 203-723-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002101
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number007785
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007359
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001688
License Number StateCT

VIII. Authorized Official

Name: MR. MICHAEL STOKES
Title or Position: OWNER
Credential: LPC
Phone: 203-572-2062