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General NPI Number Information
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NPI Number | 1619296696
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Entity Type | Organization
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Legal Business Name | A RISING STAR COUNSELING SERVICES
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Dates
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Enumeration Date | 05/31/2010
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Last Update Date | 05/31/2010
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Provider Practice Location Address
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Address Line | 25 CONCORD ST
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City | GLASTONBURY
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State | CT
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Zip | 06033-2135
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Country | US
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Telephone | 860-919-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 436 HIGH ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-2613
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Country | US
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Telephone | 860-919-3257
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY RANARD
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Credential | LPC, LADC
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Telephone | 860-919-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000816
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001581
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License Number State |
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