Individual
HOLLY HEAVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2225 MAIN ST, STRATFORD, CT 06615-5920
(203) 414-4985
Mailing address
PO BOX 11, DERBY, CT 06418-0011
(203) 414-4985
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
000752
CT
Other
Enumeration date
03/09/2020
Last updated
03/09/2020
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