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General NPI Number Information
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NPI Number | 1285013599
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Entity Type | Organization
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Legal Business Name | KALEIDOSCOPE COUNSELING & CASE MANAGEMENT LLC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 1712 AIRLINE BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3911
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Country | US
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Telephone | 757-535-9153
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Fax | 757-966-9255
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Provider Business Mailing Address
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Address Line | 1712 AIRLINE BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3911
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Country | US
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Telephone | 757-535-9153
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Fax | 757-966-9255
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Authorized Official
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Title or Position | CEO/ CO-OWNER
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Name | MS. FRANCESCA MARIA DILLARD-MOORE
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Credential | MA.ED,CSAC,BC-HSP
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Telephone | 757-535-9153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | VA
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