Provider Demographics
NPI:1114962560
Name:RANKIN BAPTIST ASSOCIATION
Entity Type:Organization
Organization Name:RANKIN BAPTIST ASSOCIATION
Other - Org Name:RANKIN BAPTIST ASSOCIATION DBA CROSSROADS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-939-6634
Mailing Address - Street 1:5611 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208
Mailing Address - Country:US
Mailing Address - Phone:601-939-6634
Mailing Address - Fax:
Practice Address - Street 1:5611 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208
Practice Address - Country:US
Practice Address - Phone:601-939-6634
Practice Address - Fax:601-420-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0323101Y00000X, 106H00000X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty