Provider Demographics
NPI:1770321903
Name:KALEIDOSCOPE CREATIVE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:KALEIDOSCOPE CREATIVE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-915-2662
Mailing Address - Street 1:40 BRITISH WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8242
Mailing Address - Country:US
Mailing Address - Phone:540-915-2662
Mailing Address - Fax:833-548-0842
Practice Address - Street 1:40 BRITISH WOODS DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-8242
Practice Address - Country:US
Practice Address - Phone:540-915-2662
Practice Address - Fax:833-548-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty