Healthcare Provider Details

I. General information

NPI: 1386460772
Provider Name (Legal Business Name): WELL BEING SANCTUARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MAIN ST STE 205
TORRINGTON CT
06790-5206
US

IV. Provider business mailing address

550 TORRINGTON RD
LITCHFIELD CT
06759-2606
US

V. Phone/Fax

Practice location:
  • Phone: 860-733-3280
  • Fax: 860-650-9854
Mailing address:
  • Phone: 203-558-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA BERTRAND
Title or Position: PRINCIPA/MANAGER
Credential: LPC
Phone: 203-558-1760