Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003136854 |
---|---|
Provider Name | Krista Nordmark |
First Address | Manchester, CT 06040-3731 |
Second Address | Manchester, CT 06040-3731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 03/06/2010 |