Organization Name: | LOTUS MOON COUNSELING CENTRE |
NPI Number: | 1366622144 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WENDY ST. GEORGE (OWNER/COUNSELOR) |
Mailing Address: | 148 Route 2 Preston |
State: | CT US |
Postal Code: | 063658520 |
Phone Number: | 8608593341 |
Fax Number: | 8607606666 |
NPI Enumeration Date: | 11/08/2007 |
NPI Last Update Date: | 11/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 001496 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |