| NPI | 1730920380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA JOHANNS Clinical Director 860-322-6392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2024-06-05 |