Healthcare Provider Details

I. General information

NPI: 1962199562
Provider Name (Legal Business Name): C&C COUNSELING AND COACHING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 PORT ST APT 928
ALEXANDRIA VA
22314-2490
US

IV. Provider business mailing address

750 PORT ST APT 928
ALEXANDRIA VA
22314-2490
US

V. Phone/Fax

Practice location:
  • Phone: 757-372-1565
  • Fax: 757-720-3517
Mailing address:
  • Phone: 347-377-0862
  • Fax: 757-720-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHANTE CROSS
Title or Position: PSYCHOTHERAPIST/ MANAGING MEMBER
Credential: M.A., L.P.C., C.L.C.
Phone: 757-372-1565