Provider Demographics
NPI:1821668625
Name:TRICOCHE, SHANICE TIANNA (LPC-A)
Entity Type:Individual
Prefix:MS
First Name:SHANICE
Middle Name:TIANNA
Last Name:TRICOCHE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 WATERTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2033
Mailing Address - Country:US
Mailing Address - Phone:340-277-3845
Mailing Address - Fax:
Practice Address - Street 1:56 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2103
Practice Address - Country:US
Practice Address - Phone:203-755-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional