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General NPI Number Information
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NPI Number | 1740036300
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Entity Type | Organization
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Legal Business Name | HOLISTIC COUNSELING AND WELLNESS LLC
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 404 THAMES ST FL 3
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City | GROTON
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State | CT
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Zip | 06340-3959
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Country | US
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Telephone | 860-245-9240
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Fax |
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Provider Business Mailing Address
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Address Line | 292 S FRONTAGE RD # 1042
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City | NEW LONDON
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State | CT
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Zip | 06320-2641
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Country | US
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Telephone | 860-245-9240
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | NICOLE SMITH
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Credential | M.A., LPC
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Telephone | 860-245-9240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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