Healthcare Provider Details

I. General information

NPI: 1407366388
Provider Name (Legal Business Name): DAHLIA COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MOUNTAIN ROAD 2ND FLOOR
SUFFIELD CT
06078
US

IV. Provider business mailing address

133 MOUNTAIN ROAD 2ND FLOOR
SUFFIELD CT
06078
US

V. Phone/Fax

Practice location:
  • Phone: 860-370-5061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE TESTA
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 860-370-5061