Healthcare Provider Details

I. General information

NPI: 1811068893
Provider Name (Legal Business Name): CHRISTIAN COUNSELING CENTER OF GREATER DANBURY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OLD NEW MILFORD ROAD LANDMARK OFFICE BUILDING SUITE 2A
BROOKFIELD CT
06804-2426
US

IV. Provider business mailing address

2 OLD NEW MILFORD ROAD LANDMARK OFFICE BUILDING SUITE 2A
BROOKFIELD CT
06804-2426
US

V. Phone/Fax

Practice location:
  • Phone: 203-775-3282
  • Fax: 203-775-3478
Mailing address:
  • Phone: 203-775-3282
  • Fax: 203-775-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number006329
License Number StateCT

VIII. Authorized Official

Name: MRS. CHERYL ANN FUSCO
Title or Position: ASSISTANT DIRECTOR
Credential: RN MHCNS
Phone: 203-775-3282