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General NPI Number Information
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NPI Number | 1336605609
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Entity Type | Organization
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Legal Business Name | CRESCENT COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 459 MAIN ST # 357
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City | TRUSSVILLE
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State | AL
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Zip | 35173-1416
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Country | US
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Telephone | 205-418-8223
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Fax | 205-708-0094
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Provider Business Mailing Address
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Address Line | 459 MAIN ST # 357
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City | TRUSSVILLE
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State | AL
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Zip | 35173-1416
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Country | US
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Telephone | 205-418-8223
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Fax | 205-708-0094
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MR. JERMAINE A WALL
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Credential | LICSW
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Telephone | 205-418-8223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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