Organization
PHOENIX PROFESSIONAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMAR DRAUGHN LPC (CLINICAL DIRECTOR)
(860) 680-9440
Entity
Organization
Contact information
Practice address
29 CONNECTICUT BLVD, EAST HARTFORD, CT 06108-3008
(860) 778-1257
Mailing address
29 CONNECTICUT BLVD, EAST HARTFORD, CT 06108-3008
(860) 778-1257
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
002311
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008046849
—
CT
Enumeration date
04/04/2014
Last updated
06/19/2014
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