Individual
MRS. ANNETTE LICKWOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
931 BANK ST, NEW LONDON, CT 06320-2702
(860) 574-8256
Mailing address
931 BANK ST, NEW LONDON, CT 06320-2702
(860) 574-8256
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
44.001570
CT
Other
Enumeration date
06/11/2024
Last updated
10/31/2024
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