Provider Demographics
NPI:1629497300
Name:CROSSROADS THERAPY LLC
Entity Type:Organization
Organization Name:CROSSROADS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:HIJIN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-877-8655
Mailing Address - Street 1:3440 TORINGDON WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3190
Mailing Address - Country:US
Mailing Address - Phone:704-325-5850
Mailing Address - Fax:704-585-1086
Practice Address - Street 1:3440 TORINGDON WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3190
Practice Address - Country:US
Practice Address - Phone:704-325-5850
Practice Address - Fax:704-585-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0067721041C0700X
NCC0068661041C0700X
NCC0059711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty