Courageous, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

COURAGEOUS, LLC

Practice address

718 Elmwood Rd
Baltimore, MD 21206-2119

Phone

(240) 676-2007

Fax

(667) 260-6455

NPI assigned

Nov 13, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jennifer Candacy Chichester-Vinston, LCPCNPI 1750036364

Title

License Clincial Professional Couns

Phone

(240) 676-2007

Specialties & licenses 1

Addresses

Other names 1

• Courageous LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Chichester-Vinston, LCPC

  • Professional Counselor
  • Baltimore, MD
  • NPI 1750036364
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1093589756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 ELMWOOD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212062119",
            "telephone_number": "240-676-2007",
            "fax_number": "667-260-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 ELMWOOD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212062119",
            "telephone_number": "240-676-2007",
            "fax_number": "667-260-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COURAGEOUS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-13",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "CHICHESTER-VINSTON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "CANDACY",
        "authorized_official_title_or_position": "LICENSE CLINCIAL PROFESSIONAL COUNS",
        "authorized_official_telephone_number": "240-676-2007",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Courageous LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Professional Counselor in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.