Provider Demographics
NPI:1295095768
Name:HALUCHAK, SHANNON (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HALUCHAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BUTTERCUP LN
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-3601
Mailing Address - Country:US
Mailing Address - Phone:203-910-9843
Mailing Address - Fax:
Practice Address - Street 1:185 BRANCH RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1984
Practice Address - Country:US
Practice Address - Phone:860-283-3030
Practice Address - Fax:860-283-3034
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional