Provider Demographics
NPI:1699392431
Name:FAIRFIELD COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:FAIRFIELD COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LADC
Authorized Official - Phone:203-581-0053
Mailing Address - Street 1:1468 BURR ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1892
Mailing Address - Country:US
Mailing Address - Phone:203-581-0053
Mailing Address - Fax:
Practice Address - Street 1:765 POST RD STE 2
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6246
Practice Address - Country:US
Practice Address - Phone:203-581-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty