Healthcare Provider Details

I. General information

NPI: 1942020375
Provider Name (Legal Business Name): COURAGEOUS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41C NEW LONDON TPKE STE 4
GLASTONBURY CT
06033-4209
US

IV. Provider business mailing address

41C NEW LONDON TPKE STE 4
GLASTONBURY CT
06033-4209
US

V. Phone/Fax

Practice location:
  • Phone: 475-331-9065
  • Fax:
Mailing address:
  • Phone: 475-331-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY MONIQUE DESORBO
Title or Position: CEO/MANAGER
Credential: LCSW
Phone: 475-331-9065