Provider Demographics
NPI:1417599846
Name:FRAZER, DAVID (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FRAZER
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CIDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06365-8501
Mailing Address - Country:US
Mailing Address - Phone:860-639-0603
Mailing Address - Fax:
Practice Address - Street 1:12 CIDER MILL RD
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:CT
Practice Address - Zip Code:06365-8501
Practice Address - Country:US
Practice Address - Phone:860-639-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003132101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral