Organization · Type 2 NPI
Holly Heaven
Mental Health Counselor · Bridgeport, CT
NPI number
1639791106
Active
Practice location
1057 Broad St Ste 304
Bridgeport, CT 06604-4219
Mailing address
PO Box 11
Derby, CT 06418-0011
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor | 101Y00000X | None listed |
| Mental Health Counselor Primary | 101YM0800X | None listed |
| Professional Counselor | 101YP2500X | None listed |
Mental Health Counselor: Definition to come...
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About NPI 1639791106
Holly Heaven's National Provider Identifier is 1639791106, issued on May 7, 2020. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Bridgeport, CT. The record was last updated on Jan 19, 2021.