Healthcare Provider Details

I. General information

NPI: 1063908507
Provider Name (Legal Business Name): GIRARD COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 GRAND ST STE 219
WATERBURY CT
06702-1914
US

IV. Provider business mailing address

405 BIOSKI RD
MIDDLEBURY CT
06762-3619
US

V. Phone/Fax

Practice location:
  • Phone: 203-423-3546
  • Fax: 203-841-1184
Mailing address:
  • Phone: 203-423-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1206
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1206
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT ASHLEY GIRARD II
Title or Position: OWNER
Credential: LMSW, LADC
Phone: 203-423-3546