| NPI | 1295336329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANGIE R MCDOUGALD Licensed Professional Counselor 860-282-8882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QC1500X Clinic/Center, Community Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2020-11-04 |