Healthcare Provider Details

I. General information

NPI: 1184998296
Provider Name (Legal Business Name): THREE GRACES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MAIN ST STE 100
OLD SAYBROOK CT
06475-2357
US

IV. Provider business mailing address

251 MAIN ST STE 100
OLD SAYBROOK CT
06475-2357
US

V. Phone/Fax

Practice location:
  • Phone: 860-661-1133
  • Fax: 860-469-2966
Mailing address:
  • Phone: 860-661-1133
  • Fax: 860-469-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUISA LYNN FOSS
Title or Position: PARTNER
Credential: PHD, NCC
Phone: 860-267-2687