Provider Demographics
NPI:1134490998
Name:AYRES, VIRGINIA PALMER (LPC LADC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:PALMER
Last Name:AYRES
Suffix:
Gender:F
Credentials:LPC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-6014
Mailing Address - Country:US
Mailing Address - Phone:203-336-5225
Mailing Address - Fax:203-336-2851
Practice Address - Street 1:4 BYINGTON PL
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3309
Practice Address - Country:US
Practice Address - Phone:203-866-2541
Practice Address - Fax:203-854-5682
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000941101YA0400X
CT002075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health