Healthcare Provider Details

I. General information

NPI: 1528534781
Provider Name (Legal Business Name): WELLNESS AT THE FARM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 S WALNUT ST SUITE D
WAUREGAN CT
06387
US

IV. Provider business mailing address

PO BOX 86
HARMONY RI
02829-0086
US

V. Phone/Fax

Practice location:
  • Phone: 860-771-9989
  • 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

VIII. Authorized Official

Name: AMBER COTE
Title or Position: OWNER, THERAPIST
Credential: LPC
Phone: 860-771-9989