Organization
EMBODYING REDEMPTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA WALLACE LMFT (OWNER)
(206) 321-8555
Entity
Organization
Contact information
Practice address
495 ORANGE ST, NEW HAVEN, CT 06511-3809
(206) 321-8555
Mailing address
872 STATE ST APT 3D, NEW HAVEN, CT 06511-7310
(206) 321-8555
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1470
CT
Other
Enumeration date
04/05/2013
Last updated
10/16/2013
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