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General NPI Number Information
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NPI Number | 1588044515
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Entity Type | Organization
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Legal Business Name | SUNRISE COUNSELING AND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 780 LYNNHAVEN PKWY SUITE 400
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7332
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Country | US
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Telephone | 757-816-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 780 LYNNHAVEN PKWY SUITE 400
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7332
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Country | US
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Telephone | 757-816-3320
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Fax |
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Authorized Official
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Title or Position | LICENCSED PROFESSIONAL COUNSELOR
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Name | RUSSELL CRAWFORD
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Credential | M.A., LPC, NCC
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Telephone | 757-816-3320
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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 | 0701006115
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License Number State | VA
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