Provider Demographics
NPI:1407214398
Name:THE CENTER FOR CHRISTIAN INITIATIVE
Entity Type:Organization
Organization Name:THE CENTER FOR CHRISTIAN INITIATIVE
Other - Org Name:THE INITIATIVE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-533-9512
Mailing Address - Street 1:60 CONNOLLY PARKWAY
Mailing Address - Street 2:BUILDING 10B SUITE 211
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3628
Mailing Address - Country:US
Mailing Address - Phone:203-626-1562
Mailing Address - Fax:203-405-0802
Practice Address - Street 1:60 CONNOLLY PKWY
Practice Address - Street 2:BUILDING 10B SUITE 211
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-626-1562
Practice Address - Fax:203-405-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2843101YP2500X
CT91021041C0700X
CT89761041C0700X
CT35631041C0700X
CT1764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty