| NPI | 1538582739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALY PHIMVONGSA Clinical Director/Owner 860-254-5127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 001470) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: CT 002227) | |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2020-02-11 |