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General NPI Number Information
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NPI Number | 1710480520
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Entity Type | Organization
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Legal Business Name | WOLF SPIRIT WELLNESS AND COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 03/18/2018
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Last Update Date | 03/18/2018
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Provider Practice Location Address
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Address Line | 125 MAIN ST N STE 2B
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City | WOODBURY
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State | CT
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Zip | 06798-2953
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Country | US
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Telephone | 203-263-3175
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Fax | 844-364-2702
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Provider Business Mailing Address
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Address Line | 236 WASHINGTON RD
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City | WOODBURY
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State | CT
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Zip | 06798-2807
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Country | US
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Telephone | 203-263-3175
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Fax | 844-364-2702
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. JULIE A LEVESQUE
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Credential | LPC
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Telephone | 203-263-3175
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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 | 3416
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License Number State | CT
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