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General NPI Number Information
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NPI Number | 1003960022
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE INC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 37 CAMP MOOWEEN ROAD
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City | LEBANON
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State | CT
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Zip | 06249
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Country | US
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Telephone | 860-889-1717
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Fax | 860-886-2361
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Provider Business Mailing Address
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Address Line | 1 MONTAUK AVE STE 301
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City | NEW LONDON
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State | CT
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Zip | 06320-4967
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Country | US
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Telephone | 860-447-1717
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Fax | 860-887-0007
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | STACEY LYNN LAWTON
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Credential | LMSW
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Telephone | 860-579-3616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0439
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA-0018
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA0020
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License Number State | CT
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