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General NPI Number Information
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NPI Number | 1205525524
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Entity Type | Organization
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Legal Business Name | CLEMENTINE COUNSELING
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 784 FARMINGTON AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1619
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Country | US
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Telephone | 860-245-9077
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Fax |
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Provider Business Mailing Address
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Address Line | 784 FARMINGTON AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1619
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Country | US
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Telephone | 860-245-9077
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | DR. KATHRYN L HENDERSON
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Credential | PHD, LPC, NCC
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Telephone | 860-245-9077
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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 |
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License Number State |
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