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General NPI Number Information
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NPI Number | 1588922470
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Entity Type | Organization
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Legal Business Name | WHERE PEACE GROWS LLC
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 380 S CENTER ST
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City | WINDSOR LOCKS
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State | CT
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Zip | 06096-2826
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Country | US
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Telephone | 860-692-2887
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Fax |
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Provider Business Mailing Address
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Address Line | 11 GARRY RD
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City | WINDSOR LOCKS
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State | CT
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Zip | 06096-2812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARISSA LLOYD
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Credential | MS, LMFT
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Telephone | 860-692-2887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001377
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License Number State | CT
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