Individual
STACIE LEIGH KERVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NCC
Contact information
Practice address
116 S BROOKSVALE RD, CHESHIRE, CT 06410-3512
(757) 621-8865
Mailing address
116 S BROOKSVALE RD, CHESHIRE, CT 06410-3512
(757) 621-8865
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001705
CT
Other
Enumeration date
07/18/2008
Last updated
07/18/2008
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