Provider Demographics
NPI:1265298533
Name:CROSSING JORDAN COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:CROSSING JORDAN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEKEISHA
Authorized Official - Middle Name:SHAUNTAE
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-212-5803
Mailing Address - Street 1:125 N BROAD ST STE 302
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-8116
Mailing Address - Country:US
Mailing Address - Phone:912-212-5803
Mailing Address - Fax:229-512-3767
Practice Address - Street 1:125 N BROAD ST STE 302
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-8116
Practice Address - Country:US
Practice Address - Phone:912-212-5803
Practice Address - Fax:229-512-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health