=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427557602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC COUNSELING OF GREATER DANBURY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2018
-----------------------------------------------------
Last Update Date | 09/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 NORTH ST
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-5604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-885-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 NORTH ST
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-5604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-885-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR/SOLE PROPRIETOR
-----------------------------------------------------
Name | HOLLY LAKIA COLON
-----------------------------------------------------
Credential | LADC, LPC
-----------------------------------------------------
Telephone | 203-885-2305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 001235
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------