| Vibrant Soul Llc | |
|
6 Way Rd Ste 217 Middlefield CT 06455-1080 | |
| (860) 994-8556 | |
| Not Available |
| Full Name | Vibrant Soul Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6 Way Rd Ste 217, Middlefield, Connecticut |
| Authorized Official Name and Position | Vanessa Lee Cosme (OWNER) |
| Authorized Official Contact | 8609948556 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vibrant Soul Llc 6 Way Rd Ste 217 Middlefield CT 06455-1080 Ph: (860) 994-8556 | Vibrant Soul Llc 6 Way Rd Ste 217 Middlefield CT 06455-1080 Ph: (860) 994-8556 |
| NPI Number | 1326632415 |
|---|---|
| Provider Enumeration Date | 03/01/2021 |
| Last Update Date | 03/28/2023 |
| Certification Date | 03/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326632415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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