Individual
KAREN MICHELLE TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
62 GRANT STREET, GRANT STREET PARTNERSHIP, NEW HAVEN, CT 06519-3456
(203) 503-3350
(203) 503-3370
Mailing address
PO BOX 7720, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-0720
(203) 503-3174
(203) 503-3183
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1305
CT
Other
Enumeration date
08/31/2018
Last updated
08/31/2018
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