=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447640131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OVERCOMING LIFE'S OBSTACLES COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2015
-----------------------------------------------------
Last Update Date | 02/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 WOLCOTT RD SUITE B
-----------------------------------------------------
City | WOLCOTT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06716-2661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-805-9919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11592
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06703-0592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-805-9919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICIAN
-----------------------------------------------------
Name | NADIYA DOLCE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 203-805-9919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 008515
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------