Healthcare Provider Details

I. General information

NPI: 1093382350
Provider Name (Legal Business Name): AGAPE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WINSTED NORFOLK ROAD
COLEBROOK CT
06021
US

IV. Provider business mailing address

PO BOX 2107
TORRINGTON CT
06790-8107
US

V. Phone/Fax

Practice location:
  • Phone: 203-558-1938
  • Fax:
Mailing address:
  • Phone: 203-558-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH RANAUDO
Title or Position: OWNER
Credential: LCSW, LADC
Phone: 203-558-1938