| NPI | 1124397518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY ALONZO WATTS Clinician 860-951-8770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: CT 007737) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2011-12-14 |