Healthcare Provider Details

I. General information

NPI: 1013582949
Provider Name (Legal Business Name): GENTLE MAMA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 BRACE RD
WEST HARTFORD CT
06107-1825
US

IV. Provider business mailing address

63 FOX RUN CT
NEWINGTON CT
06111-4584
US

V. Phone/Fax

Practice location:
  • Phone: 860-816-7516
  • Fax:
Mailing address:
  • Phone: 860-816-7516
  • 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: MISCHA ELISE HADAWAY
Title or Position: OWNER
Credential:
Phone: 860-816-7516