Individual
REVA MINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LADC
Contact information
Practice address
61 ARROW RD STE 103, WETHERSFIELD, CT 06109-1301
(959) 245-4516
Mailing address
61 ARROW RD STE 103, WETHERSFIELD, CT 06109-1301
(959) 245-4516
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
5554
CT
Other
Enumeration date
02/02/2021
Last updated
05/18/2022
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