Healthcare Provider Details

I. General information

NPI: 1255849725
Provider Name (Legal Business Name): RELEASE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 S MAIN ST STE 3A
WEST HARTFORD CT
06107-2448
US

IV. Provider business mailing address

6115 ABBOTTS BRIDGE RD APT 1303
JOHNS CREEK GA
30097-5758
US

V. Phone/Fax

Practice location:
  • Phone: 860-937-6210
  • Fax: 860-371-2660
Mailing address:
  • Phone: 860-818-3122
  • Fax: 860-371-2660

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number2883
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2883
License Number StateCT

VIII. Authorized Official

Name: MRS. ANDREA L LOVELL
Title or Position: OWNER COUNSELOR/THERAPIST
Credential: M.S. M.ED. LPC
Phone: 860-937-6210