Provider Demographics
NPI:1972981314
Name:CANDELA COUNSELING, LLC
Entity Type:Organization
Organization Name:CANDELA COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-916-2488
Mailing Address - Street 1:2911 DIXWELL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3195
Mailing Address - Country:US
Mailing Address - Phone:203-916-2488
Mailing Address - Fax:
Practice Address - Street 1:2911 DIXWELL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3195
Practice Address - Country:US
Practice Address - Phone:203-916-2488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty