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General NPI Number Information
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NPI Number | 1134629892
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Entity Type | Organization
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Legal Business Name | PHOENIX COUNSELING LLC
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 30 BRIDGE ST STE 3
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City | NEW MILFORD
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State | CT
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Zip | 06776-3517
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Country | US
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Telephone | 203-470-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 90 BALL POND RD
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City | NEW FAIRFIELD
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State | CT
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Zip | 06812-4532
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Country | US
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Telephone | 203-470-0820
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMILY FISCELLA
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Credential | LPC
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Telephone | 203-470-0820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3002
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License Number State | CT
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