Provider Demographics
NPI:1083068563
Name:CROSSROADS CENTER OF FREDERICK LLC
Entity Type:Organization
Organization Name:CROSSROADS CENTER OF FREDERICK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:LUECKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-696-1950
Mailing Address - Street 1:1890 N MARKET ST STE 301
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3033
Mailing Address - Country:US
Mailing Address - Phone:301-696-1950
Mailing Address - Fax:301-698-2661
Practice Address - Street 1:1890 N MARKET ST STE 301
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3033
Practice Address - Country:US
Practice Address - Phone:301-696-1950
Practice Address - Fax:301-698-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06287101YA0400X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty