Organization
SOUTHBURY WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECHA SULLIVAN LCSW (OWNER/MEMBER)
(203) 915-7688
Entity
Organization
Contact information
Practice address
2 POMPERAUG OFFICE PARK STE 206, SOUTHBURY, CT 06488-2291
(203) 915-7688
Mailing address
35 TIMBERLAND DR, SOUTHBURY, CT 06488-1170
(203) 915-7688
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255641072
—
CT
Enumeration date
10/20/2021
Last updated
10/20/2021
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