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General NPI Number Information
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NPI Number | 1053278960
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Entity Type | Organization
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Legal Business Name | COURAGEOUS CONNECTIONS
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 163 VICTORIA CT
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City | GRAND FORKS
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State | ND
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Zip | 58201-6144
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Country | US
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Telephone | 850-628-6321
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Fax |
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Provider Business Mailing Address
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Address Line | 163 VICTORIA CT
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City | GRAND FORKS
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State | ND
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Zip | 58201-6144
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Country | US
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Telephone | 850-628-6321
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Fax |
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Authorized Official
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Title or Position | LICENSED PROF CLINICAL COUNSELOR
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Name | ANGELA JEAN STOVALL
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Credential | LPCC-S
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Telephone | 850-628-6321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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