Miss Mya Petchark, LADC
Counselor, Addiction (Substance Use Disorder) in New London, Connecticut
1144069840- Practice location
- 931 Bank St, New London, CT 06320-2702
- Phone
- 860-574-8252
- Fax
- —
- Last updated
- May 22, 2024
Mya Petchark is a Counselor, Addiction (Substance Use Disorder) based in New London, CT. Mya Petchark practices in New London, CT and has the professional credentials of LADC. The NPI Number for Mya Petchark is 1144069840 and holds a License No. 1565 (CT). The current practice location address for Mya Petchark is 931 Bank St, New London, CT 06320-2702 and can be reached out via phone at 860-574-8252.
Provider Profile Details
- NPI Number
- 1144069840
- Provider Name
- Mya Petchark
- Credential
- LADC
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 931 Bank St, New London, CT 06320-2702
- Phone Number
- 860-574-8252
- Primary Taxonomy
- Counselor, Addiction (Substance Use Disorder) · 101YA0400X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- May 22, 2024
- Last Update Date
- May 22, 2024
- Certification Date
- May 22, 2024
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 931 Bank St
New London, CT 06320-2702 - City
- New London
- State
- Connecticut
- Zip
- 06320-2702
- Phone Number
- 860-574-8252
Provider Business Mailing Address Details
- Address
- 359 Long Hill RD Apt 22
Groton, CT 06340-3842 - City
- Groton
- State
- CT
- Zip
- 06340-3842
- Phone Number
- 860-389-4630
License Information
- License Number
- 1565
- License State
- CT
- Taxonomy
- Counselor, Addiction (Substance Use Disorder) · 101YA0400X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Counselor, Addiction (Substance Use Disorder) providers near New London, CT
View all Counselor, Addiction (Substance Use Disorder) providers in New London →- Donna E Medina, LADCCounselor, Addiction (Substance Use Disorder) · NPI 1275007353
- Dr. Kathleen Ellis, PHD, LADC, LPCCounselor, Addiction (Substance Use Disorder) · NPI 1679902316
- Joseph W Green, LADCCounselor, Addiction (Substance Use Disorder) · NPI 1780748897
- Latoya L PembertonCounselor, Addiction (Substance Use Disorder) · NPI 1952162042
- Lindsay L Helfrich, LADCCounselor, Addiction (Substance Use Disorder) · NPI 1609695915
- Mr. John T Gilleese III, LADCCounselor, Addiction (Substance Use Disorder) · NPI 1437975273
Frequently Asked Questions
What is the NPI number of Miss Mya Petchark, LADC?
The NPI number of Miss Mya Petchark, LADC is 1144069840. It was assigned on May 22, 2024 and is currently active in the NPPES registry.
What is the specialty of Miss Mya Petchark, LADC?
Miss Mya Petchark, LADC is registered under the primary taxonomy Counselor, Addiction (Substance Use Disorder) (code 101YA0400X), licensed in CT under license number 1565.
Where does Miss Mya Petchark, LADC practice?
The practice location is 931 Bank St, New London, CT 06320-2702. The office can be reached at 860-574-8252 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1144069840 directly on the NPPES registry website.