| Name: | Coordinated Counseling Services, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 07 Oct 2009 (15 years ago) |
| Identification Number: | 000514250 |
| ZIP code: | 02830 |
| County: | Providence County |
| Principal Address: | 24 BLUFF ROAD, HARRISVILLE, RI, 02830-1935, USA |
| Mailing Address: | 24 BLUFF ROAD, HARRISVILLE, RI, 02830, USA |
| Purpose: | COUNSELING SERVICES; PSYCHOTHERAPY |
| NAICS: | 621330 - Offices of Mental Health Practitioners (except Physicians) |
| Fictitious names: |
PresentSelf Counseling Services, LLC (trading name, 2022-05-27 - ) |
| Historical names: |
Coordinated Counseling Services, LLC PresentSelf Counseling, LLC |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295029262 | 2011-06-07 | 2022-06-01 | 221 KILVERT ST, WARWICK, RI, 028861343, US | 221 KILVERT ST, WARWICK, RI, 028861343, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-862-1877 |
| Phone | +1 401-328-5659 |
Authorized person
| Name | MS. CARRIE RACHEL XAVIER |
| Role | PSYCHOTHERAPIST/DIRECTOR |
| Phone | 4018621877 |
Taxonomy
| Taxonomy Code | 101Y00000X - Counselor |
| Is Primary | No |
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | No |
| Taxonomy Code | 103TC1900X - Counseling Psychologist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | MHC00375 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| MICHAEL J. BARBOZA, CPA | Agent | 24 BLUFF ROAD, HARRISVILLE, RI, 02830, USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2022-05-27 | PresentSelf Counseling, LLC | Coordinated Counseling Services, LLC |
| Name Change | 2021-10-12 | Coordinated Counseling Services, LLC | PresentSelf Counseling, LLC |
| Number | Name | File Date |
|---|---|---|
| 202455172990 | Annual Report | 2024-05-31 |
| 202336389970 | Annual Report | 2023-05-31 |
| 202218002810 | Annual Report | 2022-05-31 |
| 202218003330 | Annual Report | 2022-05-27 |
| 202218002720 | Fictitious Business Name Statement | 2022-05-27 |
| 202218002180 | Articles of Amendment | 2022-05-27 |
| 202105632870 | Annual Report | 2021-12-01 |
| 202103108700 | Articles of Amendment | 2021-10-12 |
| 202078012930 | Annual Report | 2020-11-30 |
| 201928472580 | Annual Report | 2019-11-29 |
Date of last update: 14 Oct 2024
Sources: Rhode Island Department of State
