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General NPI Number Information
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NPI Number | 1942792403
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Entity Type | Organization
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Legal Business Name | INTEGRITY CARE AND COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 16 MAIN ST
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City | ELLINGTON
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State | CT
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Zip | 06029-3360
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Country | US
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Telephone | 860-871-5402
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Fax | 860-871-5413
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Provider Business Mailing Address
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Address Line | 16 MAIN ST
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City | ELLINGTON
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State | CT
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Zip | 06029-3360
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Country | US
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Telephone | 860-871-5402
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Fax | 860-871-5413
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. JOSEPH DAVID BOIVIN
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Credential | LPC/LADC
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Telephone | 860-871-5402
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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 | 001186
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License Number State | CT
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