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General NPI Number Information
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NPI Number | 1972196988
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLARITY COUNSELING SERVICES
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 08/24/2024
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Provider Practice Location Address
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Address Line | 237 NEW RIVER DR STE 3
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5935
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Country | US
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Telephone | 910-333-1031
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Fax | 910-333-1108
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | JACKSONVILLE
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State | NC
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Zip | 28541-0007
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Country | US
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Telephone | 910-333-1031
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Fax | 910-333-1108
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MICHELLE SIRIANO
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Credential | LCMHC
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Telephone | 910-333-1031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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