Provider Demographics
NPI:1477856094
Name:COMMUNITY COUNSELING RESOURCES
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:N/A
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-488-4797
Mailing Address - Street 1:600 CRAWFORD ST STE 220
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3820
Mailing Address - Country:US
Mailing Address - Phone:757-488-4797
Mailing Address - Fax:757-488-4716
Practice Address - Street 1:600 CRAWFORD ST STE 220
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3820
Practice Address - Country:US
Practice Address - Phone:757-488-4797
Practice Address - Fax:757-488-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821435694Medicaid