Provider Demographics
NPI:1235511809
Name:KALEIDOSCOPE COUNSELING & CASE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:KALEIDOSCOPE COUNSELING & CASE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCESCA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DILLARD-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MAED,CSAC,BC-HSP,Q
Authorized Official - Phone:757-535-9153
Mailing Address - Street 1:P.O. BOX 574
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23705-0574
Mailing Address - Country:US
Mailing Address - Phone:757-535-9153
Mailing Address - Fax:757-393-0175
Practice Address - Street 1:1712 AIRLINE BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3911
Practice Address - Country:US
Practice Address - Phone:757-535-9153
Practice Address - Fax:757-966-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health