Provider Demographics
NPI:1790095081
Name:CRESCENT COUNSELING & CASEWORK SERVICES INC.
Entity Type:Organization
Organization Name:CRESCENT COUNSELING & CASEWORK SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-431-0105
Mailing Address - Street 1:708 S ROSEMONT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4061
Mailing Address - Country:US
Mailing Address - Phone:757-431-0105
Mailing Address - Fax:757-431-0106
Practice Address - Street 1:708 S ROSEMONT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4061
Practice Address - Country:US
Practice Address - Phone:757-431-0105
Practice Address - Fax:757-431-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1476251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1476OtherDBHDS LICENSE