Organization
SOUTHERN CT CHRISTIAN NETWORK
Active
Other names
Shoreline Christian Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ULARI DIKE (OFFICE MANAGER)
(203) 318-0700
Entity
Organization
Contact information
Practice address
145 DURHAM RD, MAILBOX 7, MADISON, CT 06443-2674
(203) 318-0070
(206) 339-8205
Mailing address
145 DURHAM RD, MAILBOX 7, MADISON, CT 06443-2674
(203) 318-0070
(206) 339-8205
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
001460
CT
1041C0700X
Clinical Social Worker
002876
CT
1041C0700X
Clinical Social Worker
004809
CT
2084F0202X
Forensic Psychiatry Physician
Primary
039301
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004257269
—
CT
05
—
004257277
—
CT
05
—
004257532
—
CT
01
—
307875
HEALTHNET-MHN
CT
Enumeration date
03/30/2007
Last updated
10/14/2008
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