Individual
DIANE MIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
36 RUSSELL ST, NEW BRITAIN, CT 06052-1313
(860) 223-8885
Mailing address
36 RUSSELL ST, NEW BRITAIN, CT 06052-1313
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000197
CT
Other
Enumeration date
01/11/2007
Last updated
07/08/2007
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