Provider Demographics
NPI:1720443260
Name:CROSSROADS COUNSELING SERVICES, PC
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-668-7322
Mailing Address - Street 1:505 CHESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1750
Mailing Address - Country:US
Mailing Address - Phone:302-668-7322
Mailing Address - Fax:
Practice Address - Street 1:505 CHESHIRE DR
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-1750
Practice Address - Country:US
Practice Address - Phone:302-668-7322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014417261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health