Provider Information for 1891307716
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DASHELLE GRANT BARCO LPC
Sex: Female
NPI: 1891307716
Last Updated: 2023-10-25
Certification Date: 2023-10-25
Certification Date: 2023-10-25
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1891307716 | ||||||||
| Enumeration Date | 2020-08-21 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 74 NEW LONDON TPKE GLASTONBURY, CT 06033-4204 United States Phone: 860-858-1372 | Fax: | ||||||||
| Primary Practice Address | 7 VAUXHALL ST NEW LONDON, CT 06320-5711 United States Phone: 860-442-2797 | Fax:860-701-3776 | ||||||||
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