Provider Demographics
NPI:1245461029
Name:CROSSROADS COUNSELING & MENTAL HEALTH AGENCY INC
Entity type:Organization
Organization Name:CROSSROADS COUNSELING & MENTAL HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:BURNS
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CLINICAL (MSW)
Authorized Official - Phone:347-581-5342
Mailing Address - Street 1:4084 BARRETT DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6604
Mailing Address - Country:US
Mailing Address - Phone:347-581-5342
Mailing Address - Fax:
Practice Address - Street 1:4084 BARRETT DR
Practice Address - Street 2:SUITE B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6604
Practice Address - Country:US
Practice Address - Phone:347-581-5342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8989230251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health