Healthcare Provider Details

I. General information

NPI: 1760341291
Provider Name (Legal Business Name): ITS MY LIFE COUNSELING AND WELLNESS SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MIDDLE TPKE E
MANCHESTER CT
06040-4249
US

IV. Provider business mailing address

888 SILVER LN PO BOX380171
EAST HARTFORD CT
06118-9992
US

V. Phone/Fax

Practice location:
  • Phone: 860-519-2419
  • Fax:
Mailing address:
  • Phone: 860-519-2419
  • 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: KIAJUANA DAILEY
Title or Position: OWNER/ THERAPIST
Credential: LCSW
Phone: 860-882-8427