Provider Demographics
NPI:1093176356
Name:HEALING AND TRANSFORMATIVE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:HEALING AND TRANSFORMATIVE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-305-8518
Mailing Address - Street 1:20 SHORES DR
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2555
Mailing Address - Country:US
Mailing Address - Phone:860-305-8518
Mailing Address - Fax:860-454-7236
Practice Address - Street 1:200 W CENTER ST
Practice Address - Street 2:SUITE C1-2
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4864
Practice Address - Country:US
Practice Address - Phone:860-305-8518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty