1932168689 NPI number — CROSSROADS COUNSELING SERVICES

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 1932168689 NPI number — CROSSROADS COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS COUNSELING SERVICES
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:
1932168689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28640-0212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-846-7492
Provider Business Mailing Address Fax Number:
336-846-7397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28640-9664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-846-7492
Provider Business Practice Location Address Fax Number:
336-846-7397
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GENTRY
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
MENTAL HEALTH THERAPIST AND CO-OWNE
Authorized Official Telephone Number:
336-846-7492

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3369 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: C003481 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 1903 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 3359 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4955 , 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)

  • Identifier: 6005268 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012T0 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com