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General NPI Number Information
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NPI Number | 1275959769
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Entity Type | Organization
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Legal Business Name | CULTIVATING CHANGE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 03/09/2014
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 392 MERROW RD STE B
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City | TOLLAND
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State | CT
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Zip | 06084-3974
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Country | US
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Telephone | 860-965-2443
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Fax |
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Provider Business Mailing Address
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Address Line | 4 GLORIA LN
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City | ELLINGTON
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State | CT
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Zip | 06029-2609
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Country | US
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Telephone | 860-965-2443
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Fax |
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Authorized Official
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Title or Position | CLINICIAN/MANAGER
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Name | CHRISTINE BRENTON
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Credential | LPC, LADC
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Telephone | 860-965-2443
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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 | 000964
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License Number State | CT
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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 | 002338
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001475
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6217
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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