Individual
HEATHER LEIGH BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
12 LAKEVIEW BLVD, AVON, CT 06001-3442
(860) 559-6543
Mailing address
12 LAKEVIEW BLVD, AVON, CT 06001-3442
(860) 559-6543
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4255
CT
Other
Enumeration date
10/17/2020
Last updated
10/17/2020
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