Healthcare Provider Details

I. General information

NPI: 1598645863
Provider Name (Legal Business Name): VACILLATE THEN ELEVATE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182B CAROLINE ST
DERBY CT
06418-1914
US

IV. Provider business mailing address

167 CHERRY ST STE 265
MILFORD CT
06460-3466
US

V. Phone/Fax

Practice location:
  • Phone: 475-228-0537
  • Fax:
Mailing address:
  • Phone: 475-228-0537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BREAHNNA THOMPSON
Title or Position: OWNER/LCSW
Credential: LCSW
Phone: 475-228-0537