Provider Demographics
NPI:1679331136
Name:NEW LEAF COUNSELING & WELLNESS LLC
Entity type:Organization
Organization Name:NEW LEAF COUNSELING & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EGYPCIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTOR-LOWDERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-965-1111
Mailing Address - Street 1:638 PROSPECT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4203
Mailing Address - Country:US
Mailing Address - Phone:860-965-1111
Mailing Address - Fax:
Practice Address - Street 1:638 PROSPECT AVE STE 300
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4203
Practice Address - Country:US
Practice Address - Phone:860-965-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty