Provider Demographics
NPI:1306262894
Name:CHALLENGE TO CHANGE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:CHALLENGE TO CHANGE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:203-909-0157
Mailing Address - Street 1:30 COVE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4861
Mailing Address - Country:US
Mailing Address - Phone:203-909-0157
Mailing Address - Fax:
Practice Address - Street 1:30 HAZEL TER STE 11C
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2240
Practice Address - Country:US
Practice Address - Phone:203-909-0157
Practice Address - Fax:203-903-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000963101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty