Provider Demographics
NPI:1407900525
Name:CROSSROADS COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING SERVICES, INC.
Other - Org Name:AWAKENINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:740-695-9447
Mailing Address - Street 1:255 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1040
Mailing Address - Country:US
Mailing Address - Phone:740-695-9447
Mailing Address - Fax:740-695-8895
Practice Address - Street 1:116 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:OH
Practice Address - Zip Code:43718
Practice Address - Country:US
Practice Address - Phone:740-484-4141
Practice Address - Fax:740-484-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2024-02-09
Deactivation Date:2023-08-31
Deactivation Code:
Reactivation Date:2023-10-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0072385Medicaid