Provider Demographics
NPI:1629505391
Name:TAKE COURAGE COUNSELING, LLC
Entity Type:Organization
Organization Name:TAKE COURAGE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,NCC, ACS
Authorized Official - Phone:732-705-1336
Mailing Address - Street 1:1000 ROUTE 34
Mailing Address - Street 2:BUILDING B, SUITE 302
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3473
Mailing Address - Country:US
Mailing Address - Phone:732-705-1336
Mailing Address - Fax:
Practice Address - Street 1:1000 ROUTE 34
Practice Address - Street 2:BUILDING B, SUITE 302
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3473
Practice Address - Country:US
Practice Address - Phone:732-705-1336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00409200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty