Individual
NICHOLAS GAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
70 MAIN ST, GRISWOLD, CT 06351-2226
(860) 634-0967
Mailing address
PO BOX 296, ROGERS, CT 06263-0296
(860) 634-0967
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
001066
CT
101YP2500X
Professional Counselor
Primary
2682
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1066
LADC
CT
01
—
2682
LPC
CT
Enumeration date
04/03/2012
Last updated
12/01/2020
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