Provider Demographics
NPI:1063835866
Name:CICHON, KATHERINE (LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CICHON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6152
Mailing Address - Country:US
Mailing Address - Phone:860-941-9380
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:SUITE 307
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6152
Practice Address - Country:US
Practice Address - Phone:860-941-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional