=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700173739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEEPING THE FAITH COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2011
-----------------------------------------------------
Last Update Date | 07/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 ORFORD RD
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-745-7774
-----------------------------------------------------
Fax | 410-861-6262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 91 ORFORD RD
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-745-7774
-----------------------------------------------------
Fax | 410-861-6262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAMONT MAURICE BELLE
-----------------------------------------------------
Credential | LADC
-----------------------------------------------------
Telephone | 203-745-7774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2112
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 772
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------