| NPI | 1104077759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON LEE AYOTTE STAUFFER Owner 860-989-7875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CT 006144) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2023-03-28 |