Provider Demographics
NPI:1861503922
Name:THERAPEUTIC CONNECTIONS COUNSELING AGENCY
Entity Type:Organization
Organization Name:THERAPEUTIC CONNECTIONS COUNSELING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-928-3630
Mailing Address - Street 1:9425 LINDALE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4179
Mailing Address - Country:US
Mailing Address - Phone:225-928-3630
Mailing Address - Fax:225-928-3631
Practice Address - Street 1:9425 LINDALE AVE STE E
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4179
Practice Address - Country:US
Practice Address - Phone:225-928-3630
Practice Address - Fax:225-928-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4724302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization