Organization
HARVEST WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIA WILSON LCSW (OWNER)
(475) 209-3758
Entity
Organization
Contact information
Practice address
2661 WHITNEY AVE, HAMDEN, CT 06518-2900
(475) 209-3758
Mailing address
PO BOX 4105, HAMDEN, CT 06514-0105
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649883943
—
CT
Enumeration date
08/23/2023
Last updated
08/23/2023
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