Provider Demographics
NPI:1255005575
Name:CONSULTING & COMMUNITY RESOURCES LLC
Entity Type:Organization
Organization Name:CONSULTING & COMMUNITY RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QDIP/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-409-2851
Mailing Address - Street 1:1535 MT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3511
Mailing Address - Country:US
Mailing Address - Phone:757-409-2851
Mailing Address - Fax:
Practice Address - Street 1:1535 MT VERNON AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3511
Practice Address - Country:US
Practice Address - Phone:757-409-2851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty