Provider Demographics
NPI:1649013418
Name:CSPACE COUNSELING AND COACHING LLC
Entity type:Organization
Organization Name:CSPACE COUNSELING AND COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-804-1808
Mailing Address - Street 1:547 TWIN LAKES LANE
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024
Mailing Address - Country:US
Mailing Address - Phone:571-480-1808
Mailing Address - Fax:
Practice Address - Street 1:6408 GROVEDALE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2595
Practice Address - Country:US
Practice Address - Phone:571-480-1808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health