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General NPI Number Information
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NPI Number | 1982349320
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Entity Type | Organization
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Legal Business Name | ADVANCED PSYCHOTHERAPY PRACTICE LLC
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Dates
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Enumeration Date | 04/30/2022
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 3380 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06614-4860
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Country | US
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Telephone | 203-526-1959
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Fax | 203-549-0640
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Provider Business Mailing Address
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Address Line | 193 QUINNIPIAC ST APT 2
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City | WALLINGFORD
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State | CT
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Zip | 06492-3767
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Country | US
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Telephone | 203-908-1076
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Fax | 203-526-1959
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Authorized Official
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Title or Position | OWNER
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Name | LESHAE RICE
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Credential | MS LPC-A LADC
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Telephone | 203-908-1076
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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 |
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License Number State |
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Taxonomy #2
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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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