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General NPI Number Information
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NPI Number | 1336652924
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Entity Type | Organization
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Legal Business Name | JOURNEY TOWARDS HEALING U, LLC
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 435 BUCKLAND RD STE 2
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3720
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Country | US
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Telephone | 860-436-0850
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Fax |
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Provider Business Mailing Address
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Address Line | 187 TUDOR LN APT B
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City | MANCHESTER
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State | CT
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Zip | 06042-8225
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Country | US
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Telephone | 860-712-1627
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Fax |
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Authorized Official
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Title or Position | LICENSED THERAPIST
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Name | KIMBERLY JOHNSON
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Credential | LPC
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Telephone | 860-436-0850
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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 |
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License Number State |
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