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Organization
LIFE HAPPENS
Active
Organization
LIFE HAPPENS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS R LAVINE LADC (OWNER)
(860) 456-4567
Entity
Organization
Contact information
Practice address
352 ROUTE 87, COLUMBIA, CT 06237-1422
(860) 456-4567
Mailing address
352 ROUTE 87, COLUMBIA, CT 06237-1422
(860) 456-4567
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000652
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004113031
—
CT
01
—
11243163
CAQH
CT
Enumeration date
01/20/2010
Last updated
01/20/2010
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