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General NPI Number Information
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NPI Number | 1255849725
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Entity Type | Organization
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Legal Business Name | RELEASE WELLNESS LLC
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 41 S MAIN ST STE 3A
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2448
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Country | US
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Telephone | 860-937-6210
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Fax | 860-371-2660
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Provider Business Mailing Address
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Address Line | 6115 ABBOTTS BRIDGE RD APT 1303
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City | JOHNS CREEK
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State | GA
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Zip | 30097-5758
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Country | US
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Telephone | 860-818-3122
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Fax | 860-371-2660
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Authorized Official
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Title or Position | OWNER COUNSELOR/THERAPIST
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Name | MRS. ANDREA L LOVELL
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Credential | M.S. M.ED. LPC
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Telephone | 860-937-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2883
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2883
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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