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Organization
203 PSYCHIATRY LLC
Active
Organization
203 PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY TAYLOR SPRAGUE (OFFICE MANAGER)
(843) 267-8781
Entity
Organization
Contact information
Practice address
33 UNION CITY RD STE 2D, PROSPECT, CT 06712-1550
(843) 267-8781
Mailing address
104 WAVERLY WAY APT 2, MINOT AFB, ND 58704-1072
(843) 267-8781
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/17/2022
Last updated
07/28/2022
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