| NPI | 1659838134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS MELVILLE Owner 860-796-4553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 261Q00000X | |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2019-02-21 |