Healthcare Provider Details

I. General information

NPI: 1932764651
Provider Name (Legal Business Name): CDM COUNSELING & CONSULTATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 WOLCOTT RD STE 3
WOLCOTT CT
06716-2641
US

IV. Provider business mailing address

51 N MAIN ST SUITE 3K
SOUTHINGTON CT
06489
US

V. Phone/Fax

Practice location:
  • Phone: 860-329-7672
  • Fax:
Mailing address:
  • Phone: 860-329-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: CHARLENE MOORER
Title or Position: OWNER
Credential: NCC, LPC
Phone: 860-329-7672