MEDICARE: IT'S MY LIFE COUNSELING AND WELLNESS SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	101YM0800X	Mental Health Counselor
3	101Y00000X	Counselor
4	101YA0400X	Addiction (Substance Use Disorder) Counselor
5	104100000X	Social Worker
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
7	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1760341291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IT'S MY LIFE COUNSELING AND WELLNESS SERVICES

Provider Business Mailing Address
First Line	:	888 SILVER LN
Second Line	:	PO BOX380171
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-9992
Country	:	US
Telephone Number	:	860-519-2419
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 CHESTER ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2816
Country	:	US
Telephone Number	:	860-519-2419
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ THERAPIST
Name	:	KIAJUANA DAILEY
Credential	:	LCSW
Telephone Number	:	860-519-2419

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	03/24/2026

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