Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 3824 | CT |
NPI | 1003359761 |
---|---|
Provider Name | Patrice Anthia Moulton |
First Address | Hartford, CT 06120-1153 |
Second Address | Bloomfield, CT 06002-3465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2016 |
Last Update Date | 12/12/2019 |