| NPI | 1851067524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KING Authorized 860-322-6712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist Clinical | |
| 103TC1900X Psychologist Counseling | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 2083A0300X Preventive Medicine Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant Medical | |
| 363LA2200X Nurse Practitioner Adult Health | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 364SA2100X Clinical Nurse Specialist Acute Care | |
| Enumeration Date | 2021-08-21 |
| Last Update Date | 2023-07-18 |