Individual
ALLYSON LEIGH LICESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28 RUSSETT LN, MIDDLETOWN, CT 06457-5803
(203) 206-3538
Mailing address
21 MEEKER RD, SOUTHINGTON, CT 06489-2234
(203) 206-3538
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4557
CT
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
11/01/2018
Last updated
10/26/2020
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