Healthcare Provider Details

I. General information

NPI: 1134624729
Provider Name (Legal Business Name): PEACE, HOPE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 S CENTER ST
WINDSOR LOCKS CT
06096-2822
US

IV. Provider business mailing address

380 S CENTER ST
WINDSOR LOCKS CT
06096-2822
US

V. Phone/Fax

Practice location:
  • Phone: 860-818-1175
  • Fax:
Mailing address:
  • Phone: 860-818-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number009830
License Number StateCT

VIII. Authorized Official

Name: MEAGAN ELIZABETH GAVEY
Title or Position: OWNER
Credential: LCSW
Phone: 860-818-1175