Individual
IAN ZETTERVALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LADC
Contact information
Practice address
61 BRADLEY ST, BRISTOL, CT 06010-5103
(860) 863-1937
Mailing address
135 BREWSTER RD, BRISTOL, CT 06010-5212
(860) 630-0820
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
46.003558
CT
101YA0400X
Addiction (Substance Use Disorder) Counselor
001211
CT
Other
Enumeration date
07/03/2017
Last updated
04/01/2022
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