Organization
FAITHWELL COUNSELING AND SERVICES, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIREILLE GAINES LPC (CLINICIAN)
(678) 314-4695
Entity
Organization
Contact information
Practice address
1204 MAIN ST STE 512, BRANFORD, CT 06405-3787
(678) 314-4695
(203) 481-7634
Mailing address
1204 MAIN ST STE 512, BRANFORD, CT 06405-3787
(678) 314-4695
(203) 481-7634
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154901973
—
CT
05
—
1861040065
—
CT
Enumeration date
04/14/2021
Last updated
06/08/2021
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