Provider Demographics
NPI:1083155782
Name:CHRISTIAN COUNSELING GROUP INC.
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPORTE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-496-0007
Mailing Address - Street 1:1022 MAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-4417
Mailing Address - Country:US
Mailing Address - Phone:508-496-0007
Mailing Address - Fax:508-998-9483
Practice Address - Street 1:4364 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-4614
Practice Address - Country:US
Practice Address - Phone:508-496-0007
Practice Address - Fax:508-998-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05624Medicare PIN