Provider Demographics
NPI:1275070823
Name:CHRISTIAN COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-641-5345
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-0257
Mailing Address - Country:US
Mailing Address - Phone:207-641-5345
Mailing Address - Fax:
Practice Address - Street 1:518 US ROUTE 1
Practice Address - Street 2:SUITE 11
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-2500
Practice Address - Country:US
Practice Address - Phone:207-641-5345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty