Organization Name: | KREATIVE COUNSELING ENRICHMENT SERVICES, LLC |
NPI Number: | 1003004508 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRYSTAL M RUSSELL (PROFESSIONAL COUNSELOR) |
Mailing Address: | 2110 N Beltline Blvd Columbia |
State: | SC US |
Postal Code: | 292043999 |
Phone Number: | 8032611621 |
Fax Number: | |
NPI Enumeration Date: | 10/09/2007 |
NPI Last Update Date: | 10/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 4739 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |