| NPI | 1184111023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRYSTAL L SHOUP DAQUILA Licensed Professional Counselor 860-987-7408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: CT 003065) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2018-04-17 |