| The Sacred Self, Llc | |
|
171 Market Sq Suite 102 Newington CT 06111-2927 | |
| (860) 614-8382 | |
| (860) 561-5394 |
| Full Name | The Sacred Self, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 171 Market Sq, Newington, Connecticut |
| Authorized Official Name and Position | Charleen K Miele (OWNER) |
| Authorized Official Contact | 8606148382 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Sacred Self, Llc 171 Market Sq Suite 102 Newington CT 06111-2927 Ph: (860) 614-8382 | The Sacred Self, Llc 171 Market Sq Suite 102 Newington CT 06111-2927 Ph: (860) 614-8382 |
| NPI Number | 1104227685 |
|---|---|
| Provider Enumeration Date | 09/15/2014 |
| Last Update Date | 09/15/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104227685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 002593 (Connecticut) | Primary |
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