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General NPI Number Information
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NPI Number | 1588174775
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Entity Type | Organization
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Legal Business Name | HEIDI D. HUGHART, LLC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 365 E MAIN ST STE 5
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City | BRANFORD
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State | CT
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Zip | 06405-2927
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Country | US
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Telephone | 203-415-8495
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Fax |
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Provider Business Mailing Address
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Address Line | 365 E MAIN ST STE 5
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City | BRANFORD
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State | CT
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Zip | 06405-2927
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Country | US
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Telephone | 203-415-8495
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | HEIDI D. HUGHART
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Credential | LPC
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Telephone | 203-415-8495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002902
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License Number State | CT
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