Individual
NICOLE BEALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
400 COLUMBUS AVE, ADULT PSYCHIATRIC CLINIC, NEW HAVEN, CT 06519-1233
(203) 503-3075
(203) 503-3296
Mailing address
400 COLUMBUS AVE, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-1233
(203) 503-3174
(203) 503-3183
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3121
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235918
—
CT
Enumeration date
10/23/2014
Last updated
03/21/2017
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