Healthcare Provider Details

I. General information

NPI: 1063048452
Provider Name (Legal Business Name): CONNIE JOHNSON COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 MAIN ST
RIDGEFIELD CT
06877
US

IV. Provider business mailing address

607 MAIN ST
RIDGEFIELD CT
06877
US

V. Phone/Fax

Practice location:
  • Phone: 203-313-3873
  • Fax:
Mailing address:
  • Phone: 203-313-3873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CONNIE JOHNSON
Title or Position: LPC
Credential: MA
Phone: 203-313-3873