Provider Demographics
NPI:1245683978
Name:LOTUS COUNSELING OF CONNECTICUT LLC
Entity type:Organization
Organization Name:LOTUS COUNSELING OF CONNECTICUT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCIL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-233-8174
Mailing Address - Street 1:27 SIEMON COMPANY DR
Mailing Address - Street 2:SUITE 360W
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2654
Mailing Address - Country:US
Mailing Address - Phone:203-233-8174
Mailing Address - Fax:
Practice Address - Street 1:27 SIEMON COMPANY DR
Practice Address - Street 2:SUITE 360W
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2654
Practice Address - Country:US
Practice Address - Phone:203-233-8174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002829251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health