1114151594 NPI number — CROSSROADS COUNSELING, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114151594 NPI number — CROSSROADS COUNSELING, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS COUNSELING, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114151594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5813 WRIGHTSVILLE AVE APT 170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-6527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-350-1181
Provider Business Mailing Address Fax Number:
910-350-0419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 WRIGHTSVILLE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-6336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-350-1181
Provider Business Practice Location Address Fax Number:
910-350-0419
Provider Enumeration Date:
05/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DELPILAR
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-431-5505

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1814 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com