=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649543000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HONEST LIVING CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2012
-----------------------------------------------------
Last Update Date | 02/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 258 S MAIN ST
-----------------------------------------------------
City | THOMASTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06787-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-733-4052
-----------------------------------------------------
Fax | 203-723-1403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 N HOADLEY ST
-----------------------------------------------------
City | NAUGATUCK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06770-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-733-4052
-----------------------------------------------------
Fax | 203-723-1403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. MARIE C SOLAZZO
-----------------------------------------------------
Credential | PH,D, LPC
-----------------------------------------------------
Telephone | 203-733-4052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 001360
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------