Provider Demographics
NPI:1457848533
Name:ALLISON TARDIF COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:ALLISON TARDIF COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:TARDIF
Authorized Official - Suffix:
Authorized Official - Credentials:ATR-BC, LPC, CLAT
Authorized Official - Phone:860-918-8802
Mailing Address - Street 1:642 HILLIARD ST STE 1213
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2700
Mailing Address - Country:US
Mailing Address - Phone:860-918-8802
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST STE 1213
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2700
Practice Address - Country:US
Practice Address - Phone:860-918-8802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty