Basic Information
| Provider Information | |||||||||
| NPI: | 1790345700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALING HEARTS THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 ADELAIDE ST FL 2 | ||||||||
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| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061141875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607615224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 66 CEDAR ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061112646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607615224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2019 | ||||||||
| LastUpdateDate: | 06/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | COLEY | ||||||||
| AuthorizedOfficialFirstName: | NICKESHA | ||||||||
| AuthorizedOfficialMiddleName: | YANQUIE | ||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8607615224 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.