Provider Demographics
NPI:1710480520
Name:WOLF SPIRIT WELLNESS AND COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:WOLF SPIRIT WELLNESS AND COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVESQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-263-3175
Mailing Address - Street 1:236 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2807
Mailing Address - Country:US
Mailing Address - Phone:203-263-3175
Mailing Address - Fax:844-364-2702
Practice Address - Street 1:125 MAIN ST N STE 2B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-2953
Practice Address - Country:US
Practice Address - Phone:203-263-3175
Practice Address - Fax:844-364-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3416251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health