Organization
BLACK QUIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUTUMN WRIGHT (OWNER)
(203) 892-2921
Entity
Organization
Contact information
Practice address
1355 NICHOLS AVE, STRATFORD, CT 06614-2627
(203) 892-2921
Mailing address
1355 NICHOLS AVE, STRATFORD, CT 06614-2627
(203) 892-2921
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/03/2021
Last updated
03/12/2025
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