| NPI | 1023371275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER BALLEW Medical Director 203-784-8750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2012-06-22 |