| NPI | 1871952721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE L BULLOCK Owner Operator 203-868-5436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 001538) |
| Enumeration Date | 2016-02-21 |
| Last Update Date | 2016-02-21 |