Provider Demographics
NPI:1891474557
Name:GREAT COMMISSION ASSOCIATES LLC
Entity Type:Organization
Organization Name:GREAT COMMISSION ASSOCIATES LLC
Other - Org Name:COURAGEOUS HEARTS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-376-2363
Mailing Address - Street 1:331 BROADWAY UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:331 BROADWAY UNIT 202
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1101
Practice Address - Country:US
Practice Address - Phone:401-376-2363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty