Healthcare Provider Details

I. General information

NPI: 1679939029
Provider Name (Legal Business Name): CRAYTON COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DILIGENCE DRIVE SUITE 206
NEWPORT NEWS VA
23606-4272
US

IV. Provider business mailing address

22 BELLES COVE DR APT. C
POQUOSON VA
23662-1558
US

V. Phone/Fax

Practice location:
  • Phone: 757-310-6900
  • Fax: 757-240-5936
Mailing address:
  • Phone: 757-913-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number904007102
License Number StateVA

VIII. Authorized Official

Name: MR. CHRISTOPHER CRAYTON SR.
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-913-9195