Healthcare Provider Details

I. General information

NPI: 1083342000
Provider Name (Legal Business Name): CRESCENT COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CARRIAGE CROSSING LN
MIDDLETOWN CT
06457-5867
US

IV. Provider business mailing address

115 MAIN STREET #143
EAST BERLIN CT
06023
US

V. Phone/Fax

Practice location:
  • Phone: 203-449-8299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAVIA-SIMONE BASCUINE
Title or Position: OWNER
Credential: LCSW
Phone: 203-285-8709