Individual
JACKIE SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, CLC
Contact information
Practice address
1 TURKEY HILL RD S, SUITE 2L, WESTPORT, CT 06880-5525
(646) 246-7379
Mailing address
1 TURKEY HILL RD S, SUITE 2L, WESTPORT, CT 06880-5525
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3158
CT
174N00000X
Lactation Consultant (Non-RN)
ALPP-203587
CT
Other
Enumeration date
08/28/2014
Last updated
03/31/2017
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