Individual
NICOLE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
855 LAKEWOOD RD, WATERBURY, CT 06704-5408
(888) 793-3500
Mailing address
212 PULLEN AVE, WATERBURY, CT 06708-1261
(914) 255-3132
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
9194
CT
Other
Enumeration date
10/16/2023
Last updated
12/16/2025
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