Healthcare Provider Details

I. General information

NPI: 1033232343
Provider Name (Legal Business Name): CHRISTIAN COUNSELING CENTER OF NORWALK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LEWIS ST
NORWALK CT
06851-4704
US

IV. Provider business mailing address

3 LEWIS ST
NORWALK CT
06851-4704
US

V. Phone/Fax

Practice location:
  • Phone: 203-846-4626
  • Fax:
Mailing address:
  • Phone: 203-846-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CONSTANCE LAWRENCE
Title or Position: PRESIDENT
Credential: PH.D
Phone: 203-846-4626