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General NPI Number Information
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NPI Number | 1669934337
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Entity Type | Organization
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Legal Business Name | BONDAGE BREAKERS COUNSELING, LLC
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 79 TRUMBULL ST UNIT C9
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City | NEW HAVEN
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State | CT
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Zip | 06511-3708
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Country | US
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Telephone | 203-314-9551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6434
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City | HAMDEN
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State | CT
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Zip | 06517-0434
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | BERNIC E V. MALACHI
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Credential | LPC
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Telephone | 203-314-9551
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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 |
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License Number State |
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