=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811020217
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWEET COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 258 S MAIN ST
-----------------------------------------------------
City | THOMASTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06787-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-283-8224
-----------------------------------------------------
Fax | 860-283-6079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 258 S MAIN ST
-----------------------------------------------------
City | THOMASTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06787-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-283-8224
-----------------------------------------------------
Fax | 860-283-6079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | MS. LORI KUNTZ
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 860-283-8224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 001113
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------