Healthcare Provider Details

I. General information

NPI: 1275189896
Provider Name (Legal Business Name): ALIGN THERAPY STUDIOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 WHALLEY AVE
NEW HAVEN CT
06515-1728
US

IV. Provider business mailing address

2 HILLSIDE ST
WEST HAVEN CT
06516-1024
US

V. Phone/Fax

Practice location:
  • Phone: 203-440-7633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIYAH DELORES CHARLTON
Title or Position: CO-OWNER
Credential: LPC
Phone: 203-641-0825