Organization
BALANCED LIFE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA NICOLE FORST LCSW (SOCIAL WORKER)
(860) 901-7916
Entity
Organization
Contact information
Practice address
45 FAIR ST, WALLINGFORD, CT 06492-4208
(860) 901-7916
Mailing address
2079 KILLINGLY CMNS # 1019, KILLINGLY, CT 06241-2190
(860) 901-7916
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
11/19/2021
Last updated
07/03/2023
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