Organization
SPIRIT CLINIC LLC
Active
Other names
Spirit Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTAL SAMPSON PMHNP-BC (OWNER, CLINICIAN)
(347) 622-9524
Entity
Organization
Contact information
Practice address
64 WALL ST STE 306, NORWALK, CT 06850-3403
(347) 622-9524
Mailing address
64 WALL ST STE 306, NORWALK, CT 06850-3403
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942700430
NPI
—
Enumeration date
01/05/2020
Last updated
01/05/2020
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