=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306446190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORMA JOY B-MULLINGS CAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2020
-----------------------------------------------------
Last Update Date | 11/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 BLOOMFIELD AVE STE 301
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06095-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-607-3285
-----------------------------------------------------
Fax | 860-569-7015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 BLOOMFIELD AVE STE 301285
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06095-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-324-0808
-----------------------------------------------------
Fax | 860-569-7015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CAC6637
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------