| NPI | 1851802474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE M BLACKWOOD Clinician 860-380-7228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1239) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2017-10-23 |