Provider Demographics
NPI:1013379767
Name:COURAGE COUNSELING CENTER
Entity type:Organization
Organization Name:COURAGE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROISE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-952-1900
Mailing Address - Street 1:5 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043-7820
Mailing Address - Country:US
Mailing Address - Phone:203-952-1900
Mailing Address - Fax:
Practice Address - Street 1:1268 MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3043
Practice Address - Country:US
Practice Address - Phone:203-952-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002893251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health