Healthcare Provider Details

I. General information

NPI: 1609464361
Provider Name (Legal Business Name): THE ANCHORED GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CARTER DR
MILFORD CT
06460-5604
US

IV. Provider business mailing address

23 CARTER DR
MILFORD CT
06460-5604
US

V. Phone/Fax

Practice location:
  • Phone: 203-815-9546
  • Fax:
Mailing address:
  • Phone: 203-815-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DERRICK D LEWIS
Title or Position: FOUNDER/CEO
Credential: REV.
Phone: 203-815-9546