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General NPI Number Information
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NPI Number | 1740932052
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Entity Type | Organization
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Legal Business Name | DAYSPRING THERAPEUTIC GROUP LLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 30 HAZEL TER STE 20
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2240
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Country | US
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Telephone | 203-936-9510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6685
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City | HAMDEN
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State | CT
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Zip | 06517-0685
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Country | US
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Telephone | 203-936-9510
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KHALILAH ABDULRAHIM
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Credential | LCSW
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Telephone | 203-936-9510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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