Provider Demographics
NPI:1184089096
Name:CROSSROADS CONSULTING INTERNATIONAL LLC
Entity type:Organization
Organization Name:CROSSROADS CONSULTING INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-675-2110
Mailing Address - Street 1:8930 SE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-5311
Mailing Address - Country:US
Mailing Address - Phone:772-675-2110
Mailing Address - Fax:772-675-2264
Practice Address - Street 1:8930 SE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-5311
Practice Address - Country:US
Practice Address - Phone:772-675-2110
Practice Address - Fax:772-675-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2015-125-0972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty