Healthcare Provider Details

I. General information

NPI: 1578489175
Provider Name (Legal Business Name): ARC LIGHT BEHAVIORAL HEALTH COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FAIR ST
WALLINGFORD CT
06492-4208
US

IV. Provider business mailing address

373 WARD ST
WALLINGFORD CT
06492-4614
US

V. Phone/Fax

Practice location:
  • Phone: 475-303-2473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AYNSLEY GUERTIN
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: BCBA
Phone: 475-215-3761