Organization
KETTAVONG COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALYNA KETTAVONG (OWNER)
(860) 803-9724
Entity
Organization
Contact information
Practice address
18 ONECO ST, SUITE 3, NORWICH, CT 06360-3440
(860) 822-3208
Mailing address
18 ONECO ST, SUITE 3, NORWICH, CT 06360-3440
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
06/17/2016
Last updated
08/14/2017
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