Provider Demographics
NPI:1003094780
Name:CROSSROADS RECOVERY CENTER, INCORPORATED
Entity Type:Organization
Organization Name:CROSSROADS RECOVERY CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOLLIS
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:828-659-8626
Mailing Address - Street 1:PO BOX 1864
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-1864
Mailing Address - Country:US
Mailing Address - Phone:828-659-8626
Mailing Address - Fax:828-659-6383
Practice Address - Street 1:440 E COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-1864
Practice Address - Country:US
Practice Address - Phone:828-659-8626
Practice Address - Fax:828-659-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4731101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty