Provider Demographics
NPI:1295053098
Name:COLLABORATIVE COUNSELING GROUP
Entity type:Organization
Organization Name:COLLABORATIVE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORAKWUE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-220-6595
Mailing Address - Street 1:2 CORPORATE DR
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1376
Mailing Address - Country:US
Mailing Address - Phone:203-220-6595
Mailing Address - Fax:203-445-9488
Practice Address - Street 1:2 CORPORATE DR
Practice Address - Street 2:SUITE 204A
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1376
Practice Address - Country:US
Practice Address - Phone:203-220-6595
Practice Address - Fax:203-445-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0001202181OtherMHN
CT410001290CT04OtherANTHEM