Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 003165 | CT |
NPI | 1003217159 |
---|---|
Provider Name | Charlotte T Farmer |
First Address | Norwich, CT 06360-2539 |
Second Address | Norwich, CT 06360-3440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2014 |
Last Update Date | 17/03/2018 |