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General NPI Number Information
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NPI Number | 1265990436
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Entity Type | Organization
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Legal Business Name | NAKED TRUTH LIFE ENRICHMENT PROJECT LLC
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 410 STATE ST RM 15
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3149
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Country | US
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Telephone | 203-903-8286
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Fax |
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Provider Business Mailing Address
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Address Line | 239 COLUMBUS AVE
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City | NEW HAVEN
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State | CT
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Zip | 06519-2230
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Country | US
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Telephone | 203-910-0548
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | AMELIA D. SHANNON
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Credential |
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Telephone | 203-910-0548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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