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General NPI Number Information
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NPI Number | 1427571587
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Entity Type | Organization
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Legal Business Name | SLC COUNSELING ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 545 HIGHLAND AVE
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City | CHESHIRE
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State | CT
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Zip | 06410-2205
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Country | US
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Telephone | 203-843-7434
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Fax | 203-843-7434
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Provider Business Mailing Address
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Address Line | 545 HIGHLAND AVE
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City | CHESHIRE
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State | CT
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Zip | 06410-2205
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Country | US
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Telephone | 203-843-7434
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | MR. CHRISTOPHER ABILDGAARD
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Credential | NCSP, LPC, NCC
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Telephone | 203-250-0305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002158
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License Number State | CT
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