| NPI | 1629536768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH ETCHELLS SIBORG Counselor 860-207-7464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-03-07 |