Provider Demographics
NPI:1194542886
Name:CULTIVATE CONNECTION MARRIAGE AND FAMILY THERAPY PLLC
Entity type:Organization
Organization Name:CULTIVATE CONNECTION MARRIAGE AND FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:315-552-1665
Mailing Address - Street 1:28 WILLOW WOOD PARK N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3922
Mailing Address - Country:US
Mailing Address - Phone:315-552-1665
Mailing Address - Fax:
Practice Address - Street 1:28 WILLOW WOOD PARK N
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-3922
Practice Address - Country:US
Practice Address - Phone:315-552-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty