Collaborative Change Counseling and Wellness, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2205 Issued in CT

Legal business name

COLLABORATIVE CHANGE COUNSELING AND WELLNESS, LLC

Practice address

375 Mather St
Hamden, CT 06514-3101

Phone

(203) 745-0733

NPI assigned

Mar 17, 2017

Last updated

Mar 8, 2019By 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

Jennifer A Y Johnston, M.A.NPI 1316241334

Title

Sole Proprietor

Phone

(617) 699-3101

Specialties & licenses 2

Addresses

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.

• Jennifer Ann Johnston, M.A.

  • Mental Health Counselor
  • Hamden, CT
  • NPI 1316241334
  NPD Authorized official

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

{
    "created_epoch": "1489708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552003200000",
    "number": "1831630235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 MATHER ST",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065143101",
            "telephone_number": "203-745-0733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 MATHER ST",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065143101",
            "telephone_number": "203-745-0733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Hepburn Rd",
            "address_purpose": "LOCATION",
            "city": "Hamden",
            "state": "CT",
            "postal_code": "065172925",
            "country_code": "US",
            "telephone_number": "617-699-3101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COLLABORATIVE CHANGE COUNSELING AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-17",
        "last_updated": "2019-03-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A Y",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "617-699-3101",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "7570",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "2205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaqueala Cobbs
• Daniel Aaron Cohen, LCSW,MSW,MDIV,MSJ,BA
• Jillian Taylor Cohn
• Kristyn Colafati
• Deirdra Colavolpe
• Michelle Collins, PHD
• Emmanuel Colon, LICENSED OPTICIAN
• Veronica Colon, RN
• Leila Colson, APRN
• Emily R Comer, OTR/L

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; 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.