Provider Demographics
NPI:1265544480
Name:HOUGHTALING, VIRGINIA D (LCSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:D
Last Name:HOUGHTALING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 SAYBROOK ROAD
Mailing Address - Street 2:BLDG B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-343-5385
Mailing Address - Fax:860-343-5391
Practice Address - Street 1:770 SAYBROOK ROAD
Practice Address - Street 2:BLDG B
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-343-5385
Practice Address - Fax:860-343-5391
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0010821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical