Provider Demographics
NPI:1073718573
Name:FOLKS, JEANNE CANDACE (DMIN, LPC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:CANDACE
Last Name:FOLKS
Suffix:
Gender:F
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD FARMS RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4214
Mailing Address - Country:US
Mailing Address - Phone:860-678-8779
Mailing Address - Fax:
Practice Address - Street 1:12 OLD FARMS RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4214
Practice Address - Country:US
Practice Address - Phone:860-678-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional