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General NPI Number Information
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NPI Number | 1760227334
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Entity Type | Organization
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Legal Business Name | MK COUNSELING AND WELLNESS LLC
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Dates
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Enumeration Date | 06/26/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 53 HIGH ST # A26
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City | WESTERLY
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State | RI
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Zip | 02891-6027
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Country | US
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Telephone | 860-294-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 27 BITGOOD RD
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City | GRISWOLD
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State | CT
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Zip | 06351-1503
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Country | US
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Telephone | 860-576-7834
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Fax |
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Authorized Official
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Title or Position | OWNER THERAPIST
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Name | MICHELE KELLY
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Credential |
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Telephone | 860-294-9777
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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