Organization
A TREE OF LIFE COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN N LARSON-SAMALUS LCSW (CLINICAL SOCIAL WORKER)
(860) 455-3384
Entity
Organization
Contact information
Practice address
3 BARNARD LN, 3RD FLOOR, BLOOMFIELD, CT 06002-2452
(860) 455-3384
Mailing address
10 MILLER RD, EAST GRANBY, CT 06026-9735
(860) 455-3384
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
008567
CT
Other
Enumeration date
07/16/2015
Last updated
07/16/2015
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