| NPI | 1972863256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICAH MANN Owner 860-877-4320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000689) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |