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NPI Code Detail

MEDICARE: HOLLY LAKIA COLON LPC, LADC

MEDICARE:   HOLLY LAKIA COLON  LPC, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1235CT
2101YP2500XProfessional Counselor003540CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11174607253OTHERCTMIDWESTERN CONNECTICUT COUNCIL OF ALCOHOLISM

General Provider Information

NPI Number : 1144661414
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY LAKIA COLON LPC, LADC
Provider Business Mailing Address
First Line : 7 HARWOOD DR
Second Line :
City : DANBURY
State : CT
Zip : 06810-8210
Country : US
Telephone Number : 203-885-2305
Fax Number :
Provider Business Practice Location Address
First Line : 15 NORTH ST
Second Line :
City : DANBURY
State : CT
Zip : 06810-5604
Country : US
Telephone Number : 475-219-0467
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2013
Last Update Date : 10/23/2019

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Directions to “ HOLLY LAKIA COLON LPC, LADC” Practice Location

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