Provider Demographics
NPI:1083342000
Name:CRESCENT COUNSELING AND WELLNESS LLC
Entity Type:Organization
Organization Name:CRESCENT COUNSELING AND WELLNESS LLC
Other - Org Name:CRESCENT COUNSELING AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAVIA-SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCUINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-285-8709
Mailing Address - Street 1:115 MAIN STREET
Mailing Address - Street 2:#143
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 CARRIAGE CROSSING LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5867
Practice Address - Country:US
Practice Address - Phone:203-449-8299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health