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General NPI Number Information
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NPI Number | 1184481194
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR COUNSELING
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 1500 HIGHWAY 17 N STE 201
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-6078
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Country | US
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Telephone | 508-254-0066
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Fax |
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Provider Business Mailing Address
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Address Line | 502 LUMBER ST
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City | NICHOLS
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State | SC
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Zip | 29581-5074
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Country | US
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Telephone | 508-254-0066
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Fax | 866-220-0907
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOREN MALKASIAN
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Credential | PSY.D
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Telephone | 508-254-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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