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General NPI Number Information
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NPI Number | 1790483055
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Entity Type | Organization
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Legal Business Name | CANVAS COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 3575 BRIDGE RD STE 8 # 201
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City | SUFFOLK
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State | VA
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Zip | 23435
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Country | US
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Telephone | 757-632-7107
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Fax |
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Provider Business Mailing Address
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Address Line | 3575 BRIDGE RD STE 8 #201
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City | SUFFOLK
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State | VA
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Zip | 23435
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL KITTRELL-JOHNSON
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Credential | PHD, LPC
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Telephone | 757-632-7107
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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 |
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License Number State |
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Taxonomy #2
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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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