Healthcare Provider Details

I. General information

NPI: 1003927518
Provider Name (Legal Business Name): CONNECTIONS CHRISTIAN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 N 113TH AVE C-19
YOUNGTOWN AZ
85363-1162
US

IV. Provider business mailing address

PO BOX 7328
SURPRISE AZ
85374-0105
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-7800
  • Fax:
Mailing address:
  • Phone: 623-297-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberLPC 11120
License Number StateAZ

VIII. Authorized Official

Name: MS. LENA J WRIGHT
Title or Position: OWNER/PRESIDENT
Credential: LPC
Phone: 623-297-4756