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General NPI Number Information
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NPI Number | 1588028641
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Entity Type | Organization
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Legal Business Name | THERAPY AND WELLNESS FOR WOMEN LLC
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 769 FARMINGTON AVE BOX 11
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City | FARMINGTON
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State | CT
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Zip | 06032-2364
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Country | US
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Telephone | 860-595-2890
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Fax |
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Provider Business Mailing Address
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Address Line | 769 FARMINGTON AVE BOX 11
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City | FARMINGTON
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State | CT
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Zip | 06032-2364
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Country | US
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Telephone | 860-595-2890
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. KRISTEN K WOLD
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Credential | LMFT
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Telephone | 860-595-2890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 001749
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 001744
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License Number State | CT
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