Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 3013 | MA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1114344090 |
---|---|
Provider Name | Dr. Denise Williams Coley |
First Address | Manchester, CT 06042-2007 |
Second Address | Manchester, CT 06042-2007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 27/03/2014 |