| NPI | 1962931469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH CLARENCE WILKERSON President 860-707-3999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-07-21 |