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General NPI Number Information
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NPI Number | 1083342000
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Entity Type | Organization
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Legal Business Name | CRESCENT COUNSELING AND WELLNESS LLC
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 315 CARRIAGE CROSSING LN
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City | MIDDLETOWN
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State | CT
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Zip | 06457-5867
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Country | US
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Telephone | 203-449-8299
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Fax |
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Provider Business Mailing Address
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Address Line | 115 MAIN STREET #143
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City | EAST BERLIN
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State | CT
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Zip | 06023
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAVIA-SIMONE BASCUINE
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Credential | LCSW
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Telephone | 203-285-8709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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