Healthcare Provider Details

I. General information

NPI: 1396457347
Provider Name (Legal Business Name): ROGUE WELLNESS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 WEST ST
PITTSFIELD MA
01201-5716
US

IV. Provider business mailing address

1012 WEST ST
PITTSFIELD MA
01201-5716
US

V. Phone/Fax

Practice location:
  • Phone: 413-446-6523
  • Fax:
Mailing address:
  • Phone: 413-446-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANA CONNOR
Title or Position: LICENSED INDEPENDENT CLINICAL SW
Credential: LICSW
Phone: 413-446-6523