Provider Demographics
NPI:1710607858
Name:CROSSROADS PLAY THERAPY & COUNSELING, LLC
Entity Type:Organization
Organization Name:CROSSROADS PLAY THERAPY & COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RATHKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC, RPT
Authorized Official - Phone:410-713-9380
Mailing Address - Street 1:202 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1918
Mailing Address - Country:US
Mailing Address - Phone:443-432-5519
Mailing Address - Fax:
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:MD
Practice Address - Zip Code:21826-1918
Practice Address - Country:US
Practice Address - Phone:443-432-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)