Provider Demographics
NPI:1235374430
Name:D19CRISIS
Entity Type:Organization
Organization Name:D19CRISIS
Other - Org Name:SURRY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMERGENCY SERVICES MANANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:TPSISTIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-541-6704
Mailing Address - Street 1:20 W BANK ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-3279
Mailing Address - Country:US
Mailing Address - Phone:804-541-6704
Mailing Address - Fax:804-541-6708
Practice Address - Street 1:20 W BANK ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3279
Practice Address - Country:US
Practice Address - Phone:804-541-6704
Practice Address - Fax:804-541-6708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D19CSB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health