Individual
NICHOLAS DESPOELBERCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
30 HAZEL TERRACE, SUITE 11, WOODBRIDGE, CT 06525
(203) 819-7650
Mailing address
30 HAZEL TERRACE, SUITE 11, WOODBRIDGE, CT 06525
(203) 819-7650
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2729
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008058532
DESPOELBERCH MEDICAID
CT
Enumeration date
04/15/2015
Last updated
03/31/2016
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