Healthcare Provider Details

I. General information

NPI: 1306350228
Provider Name (Legal Business Name): JGB PROFESSIONAL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 S MAIN ST STE 14
NEWTOWN CT
06470-2315
US

IV. Provider business mailing address

215 JACQUELINE DR
SOUTHBURY CT
06488-2354
US

V. Phone/Fax

Practice location:
  • Phone: 203-666-1605
  • Fax: 475-323-2144
Mailing address:
  • Phone: 203-666-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3519
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1234
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3519
License Number StateCT

VIII. Authorized Official

Name: JOSEPH G BENNER
Title or Position: OWNER
Credential: LPC, LADC
Phone: 203-666-1605