Healthcare Provider Details

I. General information

NPI: 1316197965
Provider Name (Legal Business Name): PARTNERS IN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 10/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 TUCKIE RD SUITE D
NORTH WINDHAM CT
06256-1355
US

IV. Provider business mailing address

387 TUCKIE RD SUITE D
NORTH WINDHAM CT
06256-1355
US

V. Phone/Fax

Practice location:
  • Phone: 860-423-4279
  • Fax: 860-423-4284
Mailing address:
  • Phone: 860-423-4279
  • Fax: 860-423-4284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000055
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003025
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number003025
License Number StateCT

VIII. Authorized Official

Name: MRS. MARIANNE R. CARROLL
Title or Position: MANAGER
Credential: MA,LADC
Phone: 860-423-4279