Provider Demographics
NPI:1881010288
Name:CROSSROADS COUNCELING SERVICES LLC
Entity Type:Organization
Organization Name:CROSSROADS COUNCELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEJUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LCAS-A
Authorized Official - Phone:919-225-9315
Mailing Address - Street 1:99 VILLAGE DR
Mailing Address - Street 2:SUITE 18-4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 VILLAGE DR
Practice Address - Street 2:SUITE 18-4
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7067
Practice Address - Country:US
Practice Address - Phone:919-225-9315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty