Provider Demographics
NPI:1770011454
Name:SELF-LEADERSHIP COLLABORATIVE, LLC
Entity Type:Organization
Organization Name:SELF-LEADERSHIP COLLABORATIVE, LLC
Other - Org Name:OPEN SPACE COUNSELING AND CONSULTING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CURRY-SARTORI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-575-1995
Mailing Address - Street 1:66 CEDAR ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2646
Mailing Address - Country:US
Mailing Address - Phone:860-575-1995
Mailing Address - Fax:
Practice Address - Street 1:66 CEDAR ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2646
Practice Address - Country:US
Practice Address - Phone:860-575-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty