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Organization
AUTHENTIC BALANCE CONSORTIUM LLC
Active
Organization
AUTHENTIC BALANCE CONSORTIUM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE TARRICONE LPC (PARTNER)
(860) 617-2848
Entity
Organization
Contact information
Practice address
267 WILLIMANTIC RD, SUITE 5, CHAPLIN, CT 06235-2516
(860) 617-2848
Mailing address
267 WILLIMANTIC RD, SUITE 5, CHAPLIN, CT 06235-2516
(860) 617-2848
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001484
CT
1041C0700X
Clinical Social Worker
006609
CT
Other
Enumeration date
02/04/2008
Last updated
02/04/2008
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