Provider Demographics
NPI:1255849725
Name:RELEASE WELLNESS LLC
Entity type:Organization
Organization Name:RELEASE WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER COUNSELOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS MED LPC
Authorized Official - Phone:860-937-6210
Mailing Address - Street 1:6115 ABBOTTS BRIDGE RD APT 1303
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5758
Mailing Address - Country:US
Mailing Address - Phone:860-818-3122
Mailing Address - Fax:860-371-2660
Practice Address - Street 1:41 S MAIN ST STE 3A
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2448
Practice Address - Country:US
Practice Address - Phone:860-937-6210
Practice Address - Fax:860-371-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2883101YP2500X, 261QM0850X, 261QM0855X, 261QM1300X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========Medicaid