Provider Demographics
NPI:1073079505
Name:COURAGE TO CHANGE COUNSELING LLC
Entity Type:Organization
Organization Name:COURAGE TO CHANGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:COURTNEY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:919-548-7125
Mailing Address - Street 1:402 ALAMANCE RD STE E
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6176
Mailing Address - Country:US
Mailing Address - Phone:919-548-7125
Mailing Address - Fax:
Practice Address - Street 1:402 ALAMANCE RD STE E
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6176
Practice Address - Country:US
Practice Address - Phone:919-548-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21483OtherNCSAPPB