Individual
THERESA MAMIE CHARLES I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
542 LONGHILL ROAD, GROTON, CT 06340
(866) 448-4993
Mailing address
542 LONG HILL RD, GROTON, CT 06340-4108
(860) 448-4993
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
060886125
CT
101YM0800X
Mental Health Counselor
060886125
—
Other
Enumeration date
10/23/2013
Last updated
10/23/2013
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