Healthcare Provider Details

I. General information

NPI: 1184188088
Provider Name (Legal Business Name): HAPPY AND FREE HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COLLEGE HILL RD FL 2
WARWICK RI
02886-2745
US

IV. Provider business mailing address

48 HAZARD ST
COVENTRY RI
02816-7225
US

V. Phone/Fax

Practice location:
  • Phone: 401-702-4191
  • Fax:
Mailing address:
  • Phone: 814-421-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: THERESA TEOFILAK-WILSON
Title or Position: OWNER, LMHC
Credential: LMHC
Phone: 814-421-8428