Individual
MRS. TAMMY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
151 BROAD ST, MIDDLETOWN, CT 06457-3327
(860) 346-0060
Mailing address
144 KIMBERLY RD, EAST GRANBY, CT 06026-9544
(860) 212-7956
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
002522
CT
Other
Enumeration date
01/25/2017
Last updated
01/25/2017
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