Provider Demographics
NPI:1336605609
Name:CRESCENT COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:CRESCENT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:205-418-8223
Mailing Address - Street 1:459 MAIN ST # 357
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1416
Mailing Address - Country:US
Mailing Address - Phone:205-418-8223
Mailing Address - Fax:205-708-0094
Practice Address - Street 1:459 MAIN ST # 357
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1416
Practice Address - Country:US
Practice Address - Phone:205-418-8223
Practice Address - Fax:205-708-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health