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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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