Healthcare Provider Details

I. General information

NPI: 1073914578
Provider Name (Legal Business Name): RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S MAIN ST
THOMASTON CT
06787-1734
US

IV. Provider business mailing address

14 S MAIN ST
THOMASTON CT
06787-1734
US

V. Phone/Fax

Practice location:
  • Phone: 203-578-5072
  • Fax:
Mailing address:
  • Phone: 203-578-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001328
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005428
License Number StateCT

VIII. Authorized Official

Name: HERBERT L HALL
Title or Position: OWNER
Credential: LPC
Phone: 203-578-5072