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General NPI Number Information
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NPI Number | 1265983191
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Entity Type | Organization
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Legal Business Name | CLEAR LIFE COUNSELING, LLC
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Dates
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Enumeration Date | 10/15/2016
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Last Update Date | 10/15/2016
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Provider Practice Location Address
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Address Line | 45 S MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2441
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Country | US
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Telephone | 860-414-4245
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Fax |
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Provider Business Mailing Address
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Address Line | 59 WOOD CREEK RD
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City | BURLINGTON
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State | CT
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Zip | 06013-1920
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Country | US
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Telephone | 860-395-9857
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | JACQUELINE BANASIEWICZ
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Credential |
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Telephone | 860-395-9857
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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 | 3023
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License Number State | CT
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