| Provident Properties Llc | |
|
283 Route 169 Woodstock CT 06281-0628 | |
| (860) 215-2829 | |
| Not Available |
| Full Name | Provident Properties Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 283 Route 169, Woodstock, Connecticut |
| Authorized Official Name and Position | Kristin Allard (OWNER, THERAPIST) |
| Authorized Official Contact | 8602152829 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provident Properties Llc Po Box 623 Woodstock CT 06281-0623 Ph: (860) 215-2829 | Provident Properties Llc 283 Route 169 Woodstock CT 06281-0628 Ph: (860) 215-2829 |
| NPI Number | 1932661709 |
|---|---|
| Provider Enumeration Date | 04/02/2019 |
| Last Update Date | 04/02/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932661709 | NPI | - | NPPES |
| 1164870200 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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