Provider Demographics
NPI:1063187672
Name:A WAVE OF CHANGE
Entity type:Organization
Organization Name:A WAVE OF CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE RECOVERY COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SPINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, CADC
Authorized Official - Phone:203-441-0689
Mailing Address - Street 1:PO BOX 4034
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-0034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3738
Practice Address - Country:US
Practice Address - Phone:203-263-3175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty