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General NPI Number Information
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NPI Number | 1710376629
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Entity Type | Organization
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Legal Business Name | TRINITY THERAPEUTIC CARE, LLC
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 541 EASTERN POINT RD SUITE 2
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City | GROTON
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State | CT
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Zip | 06340-5158
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Country | US
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Telephone | 860-405-1777
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Fax | 860-405-1113
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Provider Business Mailing Address
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Address Line | 541 EASTERN POINT RD SUITE 2
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City | GROTON
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State | CT
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Zip | 06340-5158
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Country | US
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Telephone | 860-705-3668
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Fax | 860-405-1113
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | DALE E KINGSLEY
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Credential | LMFT
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Telephone | 860-705-3668
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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 | 001607
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License Number State | CT
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