Organization
VINCENT A HOLLISTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT A HOLLISTER LCSW- CT, LICSW-MA (OWNER)
(860) 716-5998
Entity
Organization
Contact information
Practice address
41 MECHANIC ST, WINDSOR, CT 06095-2545
(860) 716-5998
Mailing address
99 HIGHLAND VIEW DR, SOMERS, CT 06071-1557
(860) 716-5998
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008057276
—
CT
Enumeration date
04/05/2019
Last updated
04/05/2019
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