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