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General NPI Number Information
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NPI Number | 1063187672
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Entity Type | Organization
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Legal Business Name | A WAVE OF CHANGE
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 1138 W MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06708-2730
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Country | US
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Telephone | 860-631-7303
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 W MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06708-2730
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Country | US
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Telephone | 860-631-7303
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Fax |
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Authorized Official
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Title or Position | SUBSTANCE ABUSE RECOVERY COUNSELOR
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Name | MS. ROSALIE ANNE SPINELLA
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Credential | LADC, CADC
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Telephone | 860-631-7303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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