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General NPI Number Information
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NPI Number | 1932764651
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Entity Type | Organization
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Legal Business Name | CDM COUNSELING & CONSULTATION SERVICES, LLC
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 246 WOLCOTT RD STE 3
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City | WOLCOTT
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State | CT
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Zip | 06716-2641
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Country | US
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Telephone | 860-329-7672
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Fax |
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Provider Business Mailing Address
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Address Line | 51 N MAIN ST SUITE 3K
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City | SOUTHINGTON
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State | CT
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Zip | 06489
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Country | US
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Telephone | 860-329-7672
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLENE MOORER
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Credential | NCC, LPC
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Telephone | 860-329-7672
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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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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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