Provider Demographics
NPI:1881977817
Name:SACRED INTELLIGENCE
Entity type:Organization
Organization Name:SACRED INTELLIGENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CURRY AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-443-7505
Mailing Address - Street 1:400 BAYONET ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-2600
Mailing Address - Country:US
Mailing Address - Phone:860-443-7505
Mailing Address - Fax:
Practice Address - Street 1:400 BAYONET ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2600
Practice Address - Country:US
Practice Address - Phone:860-443-7505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002364103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty