Provider Demographics
NPI:1336642008
Name:INNER WELLNESS COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:INNER WELLNESS COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-402-2825
Mailing Address - Street 1:1 WILLOWBROOK RD STE 6
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1745
Mailing Address - Country:US
Mailing Address - Phone:860-402-2825
Mailing Address - Fax:
Practice Address - Street 1:1 WILLOWBROOK RD STE 6
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1745
Practice Address - Country:US
Practice Address - Phone:860-830-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0081121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCBHP006699Medicaid