Provider Demographics
NPI:1710353792
Name:COUNSELING FOR CHANGE AND GROWTH LLC
Entity Type:Organization
Organization Name:COUNSELING FOR CHANGE AND GROWTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLERIM
Authorized Official - Middle Name:
Authorized Official - Last Name:REXHAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-608-8081
Mailing Address - Street 1:185 SILAS DEANE HWY
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-608-8081
Mailing Address - Fax:
Practice Address - Street 1:185 SILAS DEANE HWY
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-608-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty