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General NPI Number Information
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NPI Number | 1801241245
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Entity Type | Organization
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Legal Business Name | CRESCENT MOON COUNSELING, LLC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 1705 RICHLAND ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2635
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Country | US
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Telephone | 803-760-4738
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 RICHLAND ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2635
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Country | US
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Telephone | 803-760-4738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY R HERWIG
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Credential | LISW-CP
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Telephone | 803-760-4738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9781
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License Number State | SC
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