| NPI | 1457998452 |
|---|---|
| Doing Business As | SHANNON WILKS |
| Entity Type | Organization |
| Authorized Contact | SHANNON LEE WILKS Clinical Social Worker 860-812-4320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2019-12-09 |