Provider Demographics
NPI:1285013599
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:CEO/ CO-OWNER
Authorized Official - Prefix:MS
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
Authorized Official - Phone:757-535-9153
Mailing Address - Street 1:1712 AIRLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3911
Mailing Address - Country:US
Mailing Address - Phone:757-535-9153
Mailing Address - Fax:757-966-9255
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:2015-05-20
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization