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General NPI Number Information
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NPI Number | 1891454765
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC WELLNESS CARE, LLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 18 JUNIPER LANE
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City | WEST HARTFORD
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State | CT
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Zip | 06117
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Country | US
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Telephone | 860-414-4787
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 370602 12 CROSSROADS PLAZA
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City | WEST HARTFORD
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State | CT
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Zip | 06117
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Country | US
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Telephone | 860-414-4787
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Fax |
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Authorized Official
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Title or Position | OWNER, AUTHORIZED OFFICIAL
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Name | CLARISSE FAIRBANKS
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Credential | DNP, APRN, PMHCNS
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Telephone | 860-414-4787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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