Provider Demographics
NPI:1649571639
Name:COUNSELING SERVICES OF LITCHFIELD COUNTY
Entity Type:Organization
Organization Name:COUNSELING SERVICES OF LITCHFIELD COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-309-7262
Mailing Address - Street 1:200 BIRGE PARK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HARWINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06791-1909
Mailing Address - Country:US
Mailing Address - Phone:860-309-7262
Mailing Address - Fax:860-485-9375
Practice Address - Street 1:200 BIRGE PARK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HARWINTON
Practice Address - State:CT
Practice Address - Zip Code:06791-1909
Practice Address - Country:US
Practice Address - Phone:860-309-7262
Practice Address - Fax:860-485-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000935101Y00000X
CT00935101YA0400X
CT000360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty