Provider Demographics
NPI:1144744293
Name:INTEGRATIVE WELLNESS COUNSELING, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-680-0681
Mailing Address - Street 1:99 SHADOW LN APT A1
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1672
Mailing Address - Country:US
Mailing Address - Phone:631-680-0681
Mailing Address - Fax:
Practice Address - Street 1:1686 FARMINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1279
Practice Address - Country:US
Practice Address - Phone:631-680-0681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty