Healthcare Provider Details

I. General information

NPI: 1285724591
Provider Name (Legal Business Name): CHRISTINE D. PAWLIK LADC; MS; MED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 LOMBARD ST
NEW HAVEN CT
06513-2910
US

IV. Provider business mailing address

501 LOMBARD ST
NEW HAVEN CT
06513-2910
US

V. Phone/Fax

Practice location:
  • Phone: 203-787-2207
  • Fax: 203-773-3626
Mailing address:
  • Phone: 203-787-2207
  • Fax: 203-773-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0001051
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2684
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: