Healthcare Provider Details

I. General information

NPI: 1659236883
Provider Name (Legal Business Name): SEVEN TWELVE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RESERVE RD # N100
DANBURY CT
06810-5267
US

IV. Provider business mailing address

100 RESERVE RD # N100
DANBURY CT
06810-5267
US

V. Phone/Fax

Practice location:
  • Phone: 475-356-5958
  • Fax:
Mailing address:
  • Phone: 475-356-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERIKA DANIELS
Title or Position: OWNER/THERAPIST
Credential: LPC, LMHC
Phone: 475-356-5958