Provider Demographics
NPI:1548770480
Name:PIEDMONT COUNSELING AND DEVELOPMENT
Entity Type:Organization
Organization Name:PIEDMONT COUNSELING AND DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUTCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS
Authorized Official - Phone:336-442-5458
Mailing Address - Street 1:4917 PIEDMONT PKWY STE 103D
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-7536
Mailing Address - Country:US
Mailing Address - Phone:336-442-5458
Mailing Address - Fax:
Practice Address - Street 1:4917 PIEDMONT PKWY STE 103D
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-7536
Practice Address - Country:US
Practice Address - Phone:336-442-5458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006190261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)