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General NPI Number Information
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NPI Number | 1013379767
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Entity Type | Organization
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Legal Business Name | COURAGE COUNSELING CENTER
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 1268 MAIN ST STE 106
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City | NEWINGTON
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State | CT
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Zip | 06111-3043
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Country | US
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Telephone | 203-952-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 5 TANGLEWOOD LN
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City | BOLTON
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State | CT
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Zip | 06043-7820
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Country | US
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Telephone | 203-952-1900
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. JEFFREY AMBROISE
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Credential | LPC
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Telephone | 203-952-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 002893
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License Number State | CT
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