Most Relevant Information
Provider Data
| NPI Number: | 1003644618 |
| Provider Name: | MIMI PUGH LADC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 1574 |
Most Important Dates
| Enumeration Date: | 07/24/2024 |
| Last Updated: | 07/24/2024 |
Provider Practice Location
73 WALNUT ST
MANCHESTER
CT
060404954
Practice Location Phone/Fax
| Phone: | 8605065765 |
| Fax: |
Provider Mailing Location
14 HAZARD AVE # 23
ENFIELD
CT
060823713
Provider Mailing Phone/Fax
| Phone: | 8605065765 |
| Fax: |