Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CAC-5033 | CT |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CCDP-5033 |
NPI | 1003056458 |
---|---|
Provider Name | Mrs. Christina Leigh Parham |
First Address | Mansfield Center, CT 06250 |
Second Address | Mansfield Center, CT 06250-1683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2009 |
Last Update Date | 25/02/2009 |