| NPI | 1972788271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM RAYMOND HENDRIXSON Owner 203-315-8012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CT 001669) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 001669) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2012-11-30 |