Organization Name: | MIDDLETOWN COUNSELING LLC |
NPI Number: | 1215396023 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRYSTAL MOON (MANAGER) |
Mailing Address: | 34 Slicer Dr Amston |
State: | CT US |
Postal Code: | 062311327 |
Phone Number: | 8602872906 |
Fax Number: | |
NPI Enumeration Date: | 02/22/2016 |
NPI Last Update Date: | 02/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 009324 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |