Provider Demographics
NPI:1497327878
Name:CRESCENT COUNSELING GROUP
Entity Type:Organization
Organization Name:CRESCENT COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EUGENIE
Authorized Official - Middle Name:PROVOSTY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-382-6699
Mailing Address - Street 1:206 KANAWHA BLVD W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2201
Mailing Address - Country:US
Mailing Address - Phone:304-382-6699
Mailing Address - Fax:
Practice Address - Street 1:206 KANAWHA BLVD W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2201
Practice Address - Country:US
Practice Address - Phone:304-382-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty