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General NPI Number Information
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NPI Number | 1407214398
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR CHRISTIAN INITIATIVE
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 60 CONNOLLY PKWY BUILDING 10B SUITE 211
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City | HAMDEN
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State | CT
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Zip | 06514-2593
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Country | US
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Telephone | 203-626-1562
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Fax | 203-405-0802
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Provider Business Mailing Address
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Address Line | 60 CONNOLLY PARKWAY BUILDING 10B SUITE 211
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City | HAMDEN
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State | CT
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Zip | 06514-3628
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Country | US
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Telephone | 203-626-1562
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Fax | 203-405-0802
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ROGER ROGER
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Credential |
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Telephone | 203-533-9512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2843
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9102
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8976
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1764
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3563
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License Number State | CT
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