| NPI | 1508254772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE MAYNARD Owner 203-885-8723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 2461) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1011) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2014-12-22 |