Organization
THE FAMILY COUNSELING & MEDIATION CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARLENE CHISHOLM LMFT (OWNER)
(203) 736-6734
Entity
Organization
Contact information
Practice address
435 NEW HAVEN AVE, DERBY, CT 06418-2534
(203) 736-6734
(203) 736-6734
Mailing address
435 NEW HAVEN AVE, DERBY, CT 06418-2534
(203) 736-6734
(203) 736-6734
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001119
CT
106H00000X
Marriage & Family Therapist
001119
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
316439
MHN
CT
01
—
410001119CT02
ANTHEM
CT
01
—
7732883
AETNA
CT
Enumeration date
05/20/2007
Last updated
09/11/2025
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