Healthcare Provider Details

I. General information

NPI: 1043017478
Provider Name (Legal Business Name): PLACES RECOVERY AND PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 SCHOOL ST
MANCHESTER CT
06040-6184
US

IV. Provider business mailing address

212 SCHOOL ST
MANCHESTER CT
06040-6184
US

V. Phone/Fax

Practice location:
  • Phone: 860-995-2622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PRISELLA MICHELLE KING
Title or Position: CEO
Credential: LMSW, LADC
Phone: 860-995-2622