Provider Demographics
NPI:1750090643
Name:CHRISTIAN COUNSELING GROUP, INC.
Entity type:Organization
Organization Name:CHRISTIAN COUNSELING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPORTE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-496-0007
Mailing Address - Street 1:699 STATE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-2871
Mailing Address - Country:US
Mailing Address - Phone:508-496-0007
Mailing Address - Fax:508-998-2176
Practice Address - Street 1:699 STATE RD STE 5
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-2871
Practice Address - Country:US
Practice Address - Phone:508-496-0007
Practice Address - Fax:508-998-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA193200000XOtherMULTI-SPECIALTY GROUP