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General NPI Number Information
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NPI Number | 1316347933
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Entity Type | Organization
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Legal Business Name | SHORELINE WELLNESS BEHAVIORAL HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 415 MAIN ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-4296
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Country | US
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Telephone | 203-687-5580
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Fax | 203-931-0063
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Provider Business Mailing Address
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Address Line | 415 MAIN ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-4296
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Country | US
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Telephone | 203-687-5580
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Fax | 203-931-0063
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Authorized Official
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Title or Position | FOUNDER & CLINICAL DIRECTOR
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Name | MRS. CARA M POWERS
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Credential | LPC
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Telephone | 203-687-5580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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