Provider Demographics
NPI:1831692235
Name:BRITTAINEY MOLINA DBA STILL WATERS COUNSELING AND WELLNESS LLC
Entity type:Organization
Organization Name:BRITTAINEY MOLINA DBA STILL WATERS COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTAINEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-882-2652
Mailing Address - Street 1:435 BUCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3720
Mailing Address - Country:US
Mailing Address - Phone:860-882-2652
Mailing Address - Fax:
Practice Address - Street 1:435 BUCKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3720
Practice Address - Country:US
Practice Address - Phone:860-882-2652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty