Healthcare Provider Details

I. General information

NPI: 1548066681
Provider Name (Legal Business Name): RICHARDS COMPLETE WELLNESS GROUP PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BROADVIEW TER
NORWALK CT
06851-3907
US

IV. Provider business mailing address

9 BROADVIEW TER
NORWALK CT
06851-3907
US

V. Phone/Fax

Practice location:
  • Phone: 347-939-5462
  • Fax:
Mailing address:
  • Phone: 347-939-5462
  • 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 Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: DALTON L RICHARDS
Title or Position: MANAGER
Credential: LMHC
Phone: 347-939-5462