Organization
CRESCENT MOON PSYCHOTHERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUANNE IMHOLT LISW-CP (SOLE OWNER)
(313) 509-7699
Entity
Organization
Contact information
Practice address
2021 BRIDGEMILL DR, FORT MILL, SC 29707-9210
(313) 509-7699
Mailing address
1249 ASHLEY CREEK DR, MATTHEWS, NC 28105-2442
(803) 422-3779
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/01/2021
Last updated
07/01/2021
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