| NPI | 1346697224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN TREDENNICK Member 203-240-9476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 2050) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1105) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2016-05-19 |