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General NPI Number Information
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NPI Number | 1700429180
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Entity Type | Organization
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Legal Business Name | WAVES OF GROWTH THERAPY, LLC
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 2 CHAPMAN LN STE F
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City | GALES FERRY
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State | CT
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Zip | 06335-1200
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Country | US
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Telephone | 860-705-9984
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Fax |
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Provider Business Mailing Address
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Address Line | 17 RAMBLEWOOD DR
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City | GALES FERRY
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State | CT
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Zip | 06335-1641
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Country | US
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Telephone | 860-705-9984
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MIKAYLA SLEETER
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Credential | LPC
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Telephone | 860-705-9984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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