| NPI | 1588038202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALI FORTUNA Member 203-529-5250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CT 2618) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 1083) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |