Provider Demographics
NPI:1700429180
Name:WAVES OF GROWTH THERAPY, LLC
Entity Type:Organization
Organization Name:WAVES OF GROWTH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEETER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-705-9984
Mailing Address - Street 1:17 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1641
Mailing Address - Country:US
Mailing Address - Phone:860-705-9984
Mailing Address - Fax:
Practice Address - Street 1:2 CHAPMAN LN STE F
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1200
Practice Address - Country:US
Practice Address - Phone:860-705-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831558550OtherNPI NUMBER