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General NPI Number Information
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NPI Number | 1205446671
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Entity Type | Organization
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Legal Business Name | MOTIVATING CHANGE COUNSELING, LLC
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 203 BROAD ST UNIT C-4
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City | MILFORD
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State | CT
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Zip | 06460-4750
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Country | US
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Telephone | 203-290-1623
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Fax | 203-601-7056
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Provider Business Mailing Address
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Address Line | 29 BOWE AVE
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City | STRATFORD
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State | CT
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Zip | 06615-5502
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Country | US
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Telephone | 203-290-1623
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Fax | 203-601-7056
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Authorized Official
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Title or Position | OWNER
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Name | MISS CHRISTINA MCDONOUGH
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Credential | LPC, LADC
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Telephone | 203-290-1623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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