Provider Demographics
NPI:1679642672
Name:CROSSROADS THERAPY LLC
Entity Type:Organization
Organization Name:CROSSROADS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:WARCHOL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW LMFT
Authorized Official - Phone:586-226-1991
Mailing Address - Street 1:PO BOX 380452
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-0065
Mailing Address - Country:US
Mailing Address - Phone:586-226-1991
Mailing Address - Fax:586-286-1138
Practice Address - Street 1:16950 19 MILE RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-226-1991
Practice Address - Fax:586-286-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801060259104100000X
MI4101006085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty