Healthcare Provider Details

I. General information

NPI: 1205773363
Provider Name (Legal Business Name): SALTWATER PATH COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FORT HILL RD STE 3B
GROTON CT
06340-4312
US

IV. Provider business mailing address

282 NOANK LEDYARD RD
MYSTIC CT
06355-1526
US

V. Phone/Fax

Practice location:
  • Phone: 860-431-2139
  • Fax: 860-751-0349
Mailing address:
  • Phone: 401-924-1052
  • Fax: 860-751-0349

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: MRS. SHANNA REELS
Title or Position: OWNER
Credential: LCSW
Phone: 401-924-1052