Provider Demographics
NPI:1598833113
Name:ST GEORGE, WENDY LEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LEE
Last Name:ST GEORGE
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 1:67 MEETINGHOUSE LANE
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339
Mailing Address - Country:US
Mailing Address - Phone:860-705-2694
Mailing Address - Fax:
Practice Address - Street 1:163 BOSTON POST RD
Practice Address - Street 2:CONNECTIONS COUNSELING & WELLNESS CENTER
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-444-8774
Practice Address - Fax:860-444-8776
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional