Provider Demographics
NPI:1265201149
Name:THE HEALING PLUG PSYCHOTHERAPY & WELLNESS SERVICES
Entity type:Organization
Organization Name:THE HEALING PLUG PSYCHOTHERAPY & WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:T'KEYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:860-474-3709
Mailing Address - Street 1:34 JEROME AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2463
Mailing Address - Country:US
Mailing Address - Phone:860-474-3709
Mailing Address - Fax:
Practice Address - Street 1:34 JEROME AVE STE 320
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2463
Practice Address - Country:US
Practice Address - Phone:860-474-3709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty