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General NPI Number Information
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NPI Number | 1790095081
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Entity Type | Organization
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Legal Business Name | CRESCENT COUNSELING & CASEWORK SERVICES INC.
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 708 S ROSEMONT RD SUITE 203
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4061
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Country | US
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Telephone | 757-431-0105
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Fax | 757-431-0106
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Provider Business Mailing Address
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Address Line | 708 S ROSEMONT RD SUITE 203
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4061
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Country | US
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Telephone | 757-431-0105
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Fax | 757-431-0106
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. RODNEY THOMAS MALONE
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Credential | PH.D.
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Telephone | 757-431-0105
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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 | 1476
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License Number State | VA
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