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General NPI Number Information
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NPI Number | 1154090876
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Entity Type | Organization
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Legal Business Name | CROSSVINE CLINICAL GROUP, PLLC
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 140 WIND CHIME CT STE A
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City | RALEIGH
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State | NC
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Zip | 27615-6580
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Country | US
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Telephone | 919-946-3224
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 WHIPPOORWILL LN
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City | RALEIGH
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State | NC
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Zip | 27609-3643
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Country | US
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Telephone | 919-813-9415
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOLLY BLANC MOSES
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Credential |
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Telephone | 919-813-9415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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