Grey Street Counseling Center LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

GREY STREET COUNSELING CENTER LLC

Practice address

504 Wolcott Rd Ste D
Wolcott, CT 06716-2462

Phone

(203) 441-7557

NPI assigned

Oct 2, 2023

Last updated

Jan 5, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dana Wallace, LPCNPI 1255059382

Title

Owner

Phone

(203) 441-7557

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dana Wallace, LPC

  • Professional Counselor
  • Wolcott, CT
  • NPI 1255059382
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1215717962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 WOLCOTT RD STE D",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067162462",
            "telephone_number": "203-441-7557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 WOLCOTT RD STE D",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067162462",
            "telephone_number": "203-441-7557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREY STREET COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-02",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-441-7557",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Kathleen Girouard
• Martin B. Goldstein, D.M.D.
• Jeffrey Gonzalez, LPC-A
• Marrhonda Goodwin
• Rachel Gorneault, PTA
• Theresa Maureen Grey, COTA/L
• Amy Lisa Guyette, LPC
• Gayle Gwozdz, A.P.R.N.
• Amber S Hayes, PT
• Jaylin Holland, ND

• Professional Counselor in Wolcott, CT
• Providers in Wolcott, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.