| NPI | 1356956528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SHACKFORD Practice Manager/Registered Agent 860-245-9372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2025-01-28 |