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General NPI Number Information
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NPI Number | 1942020375
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Entity Type | Organization
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Legal Business Name | COURAGEOUS COUNSELING LLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 41C NEW LONDON TPKE STE 4
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City | GLASTONBURY
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State | CT
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Zip | 06033-4209
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Country | US
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Telephone | 475-331-9065
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Fax |
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Provider Business Mailing Address
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Address Line | 41C NEW LONDON TPKE STE 4
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City | GLASTONBURY
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State | CT
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Zip | 06033-4209
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Country | US
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Telephone | 475-331-9065
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGER
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Name | LINDSEY MONIQUE DESORBO
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Credential | LCSW
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Telephone | 475-331-9065
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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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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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