Individual
MR. GORDON WESLEY LYDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAC, CADC
Contact information
Practice address
76 JACKSON ST, TORRINGTON, CT 06790-6202
(860) 491-8511
Mailing address
76 JACKSON ST, TORRINGTON, CT 06790-6202
(860) 491-8511
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096272748
—
CT
Enumeration date
02/13/2020
Last updated
02/13/2020
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