Organization
INTO THE WOODS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTLE SULLIVAN LPC (CLINICIAN)
(860) 412-4547
Entity
Organization
Contact information
Practice address
760 BANTAM RD, BANTAM, CT 06750-1603
(860) 412-4547
Mailing address
760 BANTAM RD, BANTAM, CT 06750-1603
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
10/11/2018
Last updated
10/11/2018
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