Healthcare Provider Details

I. General information

NPI: 1851942403
Provider Name (Legal Business Name): HEALING HOUSE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CENTERPOINT DR STE 613
MIDDLETOWN CT
06457-7570
US

IV. Provider business mailing address

515 CENTERPOINT DR STE 613
MIDDLETOWN CT
06457-7570
US

V. Phone/Fax

Practice location:
  • Phone: 860-574-3959
  • Fax:
Mailing address:
  • Phone: 860-574-3959
  • 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: CRYSTAL ROACH
Title or Position: OWNER/CEO
Credential: LCSW
Phone: 860-574-3959