Provider Demographics
NPI:1184188088
Name:HAPPY AND FREE HEALING
Entity Type:Organization
Organization Name:HAPPY AND FREE HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMHC
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEOFILAK-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:814-421-8428
Mailing Address - Street 1:48 HAZARD ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-7225
Mailing Address - Country:US
Mailing Address - Phone:814-421-8428
Mailing Address - Fax:
Practice Address - Street 1:21 COLLEGE HILL RD FL 2
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2745
Practice Address - Country:US
Practice Address - Phone:401-702-4191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1356735211Medicaid
1356735211OtherNPI 1