Provider Demographics
NPI:1639516032
Name:ROAD TO WELLNESS, LLC
Entity Type:Organization
Organization Name:ROAD TO WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEESHA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GRIER-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-654-1367
Mailing Address - Street 1:2911 DIXWELL AVE
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3195
Mailing Address - Country:US
Mailing Address - Phone:203-654-1367
Mailing Address - Fax:203-889-4926
Practice Address - Street 1:2911 DIXWELL AVE
Practice Address - Street 2:SUITE B-5
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3195
Practice Address - Country:US
Practice Address - Phone:203-654-1367
Practice Address - Fax:203-889-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003271261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health