Healthcare Provider Details

I. General information

NPI: 1518435841
Provider Name (Legal Business Name): JENNIFER CHRISTIANSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 05/19/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LAFAYETTE ST
NORWICH CT
06360-2708
US

IV. Provider business mailing address

119 LAFAYETTE ST
NORWICH CT
06360-2708
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-0097
  • Fax: 860-969-0879
Mailing address:
  • Phone: 860-460-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3615
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3615
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: