Individual
MS. LYDIA PRUDENCE PERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LADC
Contact information
Practice address
1 FORT HILL RD STE 6, GROTON, CT 06340-4799
(860) 705-9630
Mailing address
12 WATER ST APT 304, MYSTIC, CT 06355-2534
(860) 705-9630
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1256
CT
101YP2500X
Professional Counselor
Primary
4323
CT
Other
Enumeration date
09/05/2017
Last updated
11/10/2023
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