Healthcare Provider Details

I. General information

NPI: 1255452686
Provider Name (Legal Business Name): PETER RALSTON LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 NAGY RD
ASHFORD CT
06278-2328
US

IV. Provider business mailing address

39 NAGY RD
ASHFORD CT
06278-2328
US

V. Phone/Fax

Practice location:
  • Phone: 860-634-4611
  • Fax:
Mailing address:
  • Phone: 860-634-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001133
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number000533
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: