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General NPI Number Information
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NPI Number | 1497016885
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTER FOR WOMEN AND CHILDREN, LLC
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Dates
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Enumeration Date | 06/03/2012
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Last Update Date | 06/03/2012
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Provider Practice Location Address
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Address Line | 1224 MILL ST BUILDING B, SUITE 103
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City | EAST BERLIN
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State | CT
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Zip | 06023-1159
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Country | US
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Telephone | 860-575-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 25 LORI LN
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City | MERIDEN
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State | CT
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Zip | 06450-3574
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Country | US
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Telephone | 203-715-2042
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA CARR
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Credential | LPC
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Telephone | 860-575-4144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002119
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License Number State | CT
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