Provider Demographics
NPI:1972196988
Name:CRYSTAL CLARITY COUNSELING SERVICES
Entity Type:Organization
Organization Name:CRYSTAL CLARITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:910-333-1031
Mailing Address - Street 1:715 GUM BRANCH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6427
Mailing Address - Country:US
Mailing Address - Phone:910-333-1031
Mailing Address - Fax:910-333-1108
Practice Address - Street 1:715 GUM BRANCH RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6427
Practice Address - Country:US
Practice Address - Phone:412-552-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1114277027OtherTRICARE
NC1114277027OtherEMPLOYEE ASSISTANCE PROGRAM
NC1114277027OtherBLUE CROSS BLUE SHIELD
NC11142777027OtherAETNA