Healthcare Provider Details

I. General information

NPI: 1700173739
Provider Name (Legal Business Name): KEEPING THE FAITH COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 ORFORD RD
WEST HAVEN CT
06516-1130
US

IV. Provider business mailing address

91 ORFORD RD
WEST HAVEN CT
06516-1130
US

V. Phone/Fax

Practice location:
  • Phone: 203-745-7774
  • Fax: 410-861-6262
Mailing address:
  • Phone: 203-745-7774
  • Fax: 410-861-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number772
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2112
License Number StateCT

VIII. Authorized Official

Name: LAMONT MAURICE BELLE
Title or Position: OWNER
Credential: LADC
Phone: 203-745-7774