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Organization
CREATIVE COACHING AND ADDICTION COUNSELING LLC
Active
Organization
CREATIVE COACHING AND ADDICTION COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK RYAN (THERAPIST/MANAGER)
(602) 391-3589
Entity
Organization
Contact information
Practice address
998 FARMINGTON AVE, 106A LL, WEST HARTFORD, CT 06107-2162
(602) 391-3589
Mailing address
53 MANOR LN, SOUTH WINDSOR, CT 06074-3214
(602) 391-3589
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/04/2016
Last updated
11/04/2016
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