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General NPI Number Information
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NPI Number | 1265941579
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Entity Type | Organization
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Legal Business Name | RENEWING MINDS COUNSELING LLC
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 969 W MAIN ST STE 2G
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City | WATERBURY
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State | CT
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Zip | 06708-2666
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Country | US
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Telephone | 203-872-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 969 W MAIN ST STE 2G
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City | WATERBURY
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State | CT
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Zip | 06708-2666
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Country | US
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Telephone | 203-525-1196
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Fax | 844-847-7193
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Authorized Official
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Title or Position | OWNER
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Name | BRITTNEY WILKES
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Credential | LPC
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Telephone | 203-872-5577
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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 | 003086
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License Number State | CT
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