Healthcare Provider Details

I. General information

NPI: 1720322761
Provider Name (Legal Business Name): COURAGEOUS LIVING COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N PRICE ST STE A
POTTSTOWN PA
19464-4912
US

IV. Provider business mailing address

22 N PRICE ST STE A
POTTSTOWN PA
19464-4912
US

V. Phone/Fax

Practice location:
  • Phone: 215-859-1252
  • Fax: 215-701-5726
Mailing address:
  • Phone: 215-859-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006492
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLEY LYNN GIANNETTI
Title or Position: PARTNER AND PROFESSIONAL COUNSELOR
Credential: LPC, NCC
Phone: 215-859-1252