Provider Demographics
NPI:1922446566
Name:PERSONAL DEVELOPMENT LLC
Entity Type:Organization
Organization Name:PERSONAL DEVELOPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-383-9872
Mailing Address - Street 1:323 WEBB CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1453
Mailing Address - Country:US
Mailing Address - Phone:203-383-9872
Mailing Address - Fax:
Practice Address - Street 1:238 MONROE TPKE
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-6200
Practice Address - Country:US
Practice Address - Phone:203-383-9872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty