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General NPI Number Information
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NPI Number | 1306262894
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Entity Type | Organization
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Legal Business Name | CHALLENGE TO CHANGE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 03/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 30 HAZEL TER STE 11C
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2240
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Country | US
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Telephone | 203-909-0157
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Fax | 203-903-5536
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Provider Business Mailing Address
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Address Line | 30 COVE BROOK RD
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City | WEST HAVEN
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State | CT
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Zip | 06516-4861
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Country | US
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Telephone | 203-909-0157
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DONNAMARIE RIVERA
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Credential | LADC
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Telephone | 203-909-0157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000963
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License Number State | CT
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