Healthcare Provider Details

I. General information

NPI: 1104025378
Provider Name (Legal Business Name): MICHELLE-LISA WELLER VOEGTLE L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 GLEASONS LANDING CT
SAINT HELENA ISLAND SC
29920-3816
US

IV. Provider business mailing address

2 WESTRIDGE DRIVE
SIMSBURY CT
06070
US

V. Phone/Fax

Practice location:
  • Phone: 860-309-1013
  • Fax:
Mailing address:
  • Phone: 860-309-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001591
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: