Provider Demographics
NPI:1760039937
Name:DIRECT REALISTIC COUNSELING SERVICE
Entity Type:Organization
Organization Name:DIRECT REALISTIC COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMEN
Authorized Official - Middle Name:RAHEEM
Authorized Official - Last Name:CROMWELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:DR
Authorized Official - Phone:919-332-9294
Mailing Address - Street 1:212 CRESTDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5515
Mailing Address - Country:US
Mailing Address - Phone:919-706-9448
Mailing Address - Fax:
Practice Address - Street 1:503 HIGHWAY 70
Practice Address - Street 2:SUITE R
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-706-9448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty