Provider Demographics
NPI:1164652871
Name:SOUTHERN CONNECTICUT CHRISTIAN COUNSELING CENTER
Entity Type:Organization
Organization Name:SOUTHERN CONNECTICUT CHRISTIAN COUNSELING CENTER
Other - Org Name:RENEW COUNSELING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMIN
Authorized Official - Phone:203-255-5078
Mailing Address - Street 1:8 WAKEMAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5120
Mailing Address - Country:US
Mailing Address - Phone:203-255-5078
Mailing Address - Fax:
Practice Address - Street 1:8 WAKEMAN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5120
Practice Address - Country:US
Practice Address - Phone:203-255-5078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty