| NPI | 1285084517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALYNA KETTAVONG Owner 860-803-9724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2017-08-14 |