=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568234102
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABATON COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2023
-----------------------------------------------------
Last Update Date | 10/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 OLD KINGS HWY S
-----------------------------------------------------
City | DARIEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06820-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-570-7721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 YATES BLVD
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12601-5035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-570-7721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CANDIDA STARR JONES
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 505-570-7721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------