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General NPI Number Information
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NPI Number | 1508254772
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Entity Type | Organization
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Legal Business Name | BALANCE HEALING GROUP LLC
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 152 DEER HILL AVE SUITE 119
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City | DANBURY
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State | CT
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Zip | 06810-7791
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Country | US
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Telephone | 203-885-8723
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Fax |
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Provider Business Mailing Address
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Address Line | 152 DEER HILL AVE SUITE 119
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City | DANBURY
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State | CT
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Zip | 06810-7791
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Country | US
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Telephone | 203-885-8723
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE MAYNARD
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Credential | LPC
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Telephone | 203-885-8723
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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 | 1011
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2461
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License Number State | CT
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