| NPI | 1770249880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE ROACH Practice Administrator 860-368-7092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2023-01-14 |