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Organization
COMMUNITY CHILD GUIDANCE CLINIC, INC.
Active
Organization
COMMUNITY CHILD GUIDANCE CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLIFFORD JOHNSON LCSW (EXECUTIVE DIRECTOR)
(860) 643-2101
Entity
Organization
Contact information
Practice address
317 N MAIN ST, MANCHESTER, CT 06042-2007
(860) 643-2101
(860) 645-1470
Mailing address
317 N MAIN ST, MANCHESTER, CT 06042-2007
(860) 643-2101
(860) 645-1470
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
0238
CT
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
OPCC-14
CT
Other
Enumeration date
01/26/2007
Last updated
05/03/2013
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