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Organization

AUTHENTIC BALANCE CONSORTIUM LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DIANE TARRICONE LPC (PARTNER)
(860) 617-2848
Entity
Organization

Contact information

Practice address
267 WILLIMANTIC RD, SUITE 5, CHAPLIN, CT 06235-2516
(860) 617-2848
Mailing address
267 WILLIMANTIC RD, SUITE 5, CHAPLIN, CT 06235-2516
(860) 617-2848

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001484
CT
1041C0700X
Clinical Social Worker
006609
CT

Other

Enumeration date
02/04/2008
Last updated
02/04/2008
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