Provider Demographics
NPI:1346301660
Name:CROSSROADS PSYCHIATRIC GROUP, PA
Entity Type:Organization
Organization Name:CROSSROADS PSYCHIATRIC GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-292-1510
Mailing Address - Street 1:600 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7722
Mailing Address - Country:US
Mailing Address - Phone:336-292-1510
Mailing Address - Fax:336-292-0679
Practice Address - Street 1:600 GREEN VALLEY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7722
Practice Address - Country:US
Practice Address - Phone:336-292-1510
Practice Address - Fax:336-292-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790270WMedicaid
NC790270WMedicaid