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General NPI Number Information
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NPI Number | 1336680156
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Entity Type | Organization
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Legal Business Name | LIVE BY THE SUN FEEL BY THE MOON
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 128 GARDEN ST
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City | FARMINGTON
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State | CT
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Zip | 06032-2254
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Country | US
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Telephone | 860-716-5318
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Fax | 860-231-8006
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Provider Business Mailing Address
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Address Line | 128 GARDEN ST
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City | FARMINGTON
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State | CT
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Zip | 06032-2254
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Country | US
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Telephone | 860-716-5318
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Fax | 860-231-8006
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | GINA GOLDSTEIN
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Credential | M.S., LPC
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Telephone | 860-716-5318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 003036
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License Number State | CT
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