Organization
GENERATION OF LEADERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANYA RANDALL (ADMINISTRATOR)
(475) 201-8549
Entity
Organization
Contact information
Practice address
157 CHURCH ST FL 19, NEW HAVEN, CT 06510-2100
(203) 787-8232
Mailing address
213 GORHAM AVE, HAMDEN, CT 06514-3903
(203) 787-8232
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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