Provider Demographics
NPI:1396978912
Name:CROSS CREEK FAMILY SERVICES
Entity type:Organization
Organization Name:CROSS CREEK FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-273-5066
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-0432
Mailing Address - Country:US
Mailing Address - Phone:910-222-8193
Mailing Address - Fax:910-488-1122
Practice Address - Street 1:150B SQUARE LN
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:NC
Practice Address - Zip Code:28386-9035
Practice Address - Country:US
Practice Address - Phone:910-222-8193
Practice Address - Fax:910-488-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty