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General NPI Number Information
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NPI Number | 1639685456
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Entity Type | Organization
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Legal Business Name | INTEGRATED COUNSELING SOLUTIONS, LLC
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 363 MAIN ST STE 512
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3359
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Country | US
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Telephone | 860-373-8698
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Fax |
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Provider Business Mailing Address
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Address Line | 32 WOOD ACRES RD
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City | AMSTON
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State | CT
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Zip | 06231-1751
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Country | US
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Telephone | 860-373-8698
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MS. CHARLENE DENISE KEELER
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Credential | LPC
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Telephone | 860-373-8698
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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 | 002445
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License Number State | CT
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