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Organization
SOUTHBURY ADOLESCENT AND YOUNG ADULT COUNSELING CENTER
Active
Organization
SOUTHBURY ADOLESCENT AND YOUNG ADULT COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENDAN STACK LPC (OWNER, LPC)
(518) 610-4528
Entity
Organization
Contact information
Practice address
519 HERITAGE RD STE 2A5, SOUTHBURY, CT 06488-6694
(203) 568-5923
Mailing address
127 WATERTOWN RD, MIDDLEBURY, CT 06762-1502
(518) 610-4528
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/15/2020
Last updated
08/03/2025
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