Provider Demographics
NPI:1871677484
Name:CHRISTIAN COUNSELING CENTER OF SE CT, INC.
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING CENTER OF SE CT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-449-1382
Mailing Address - Street 1:214B THAMES ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3632
Mailing Address - Country:US
Mailing Address - Phone:860-449-1382
Mailing Address - Fax:860-449-1384
Practice Address - Street 1:214B THAMES ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3632
Practice Address - Country:US
Practice Address - Phone:860-449-1382
Practice Address - Fax:860-449-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty