Organization
CHAISE LOUNGE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAYNA PROVENCHER LCSW (OWNER/PROVIDER)
(860) 237-3273
Entity
Organization
Contact information
Practice address
164 HEMPSTEAD ST, NEW LONDON, CT 06320-5638
(860) 237-3273
Mailing address
112 NEW LONDON RD UNIT 1-310, GROTON, CT 06340-4869
(860) 639-4893
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/06/2025
Last updated
02/17/2025
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