Provider Demographics
NPI:1093589756
Name:COURAGEOUS, LLC
Entity Type:Organization
Organization Name:COURAGEOUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE CLINCIAL PROFESSIONAL COUNS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CANDACY
Authorized Official - Last Name:CHICHESTER-VINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-676-2007
Mailing Address - Street 1:718 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2119
Mailing Address - Country:US
Mailing Address - Phone:240-676-2007
Mailing Address - Fax:410-421-7000
Practice Address - Street 1:718 ELMWOOD ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206
Practice Address - Country:US
Practice Address - Phone:240-676-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty