Healthcare Provider Details

I. General information

NPI: 1134737760
Provider Name (Legal Business Name): HEALING SPRINGS WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 HIGHLAND AVE STE 11
CHESHIRE CT
06410-2255
US

IV. Provider business mailing address

475 KEENEY ST
MANCHESTER CT
06040-7027
US

V. Phone/Fax

Practice location:
  • Phone: 860-385-1472
  • Fax:
Mailing address:
  • Phone: 203-526-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAWNIEL CHAMANLAL
Title or Position: OWNER
Credential: LCSW
Phone: 203-526-3408