| NPI | 1164920559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA CASSELL Billing Agent 860-405-4951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00538) |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2018-01-31 |