Provider Demographics
NPI:1780722801
Name:CROSBY, TIJUANA MCLEOD (MA)
Entity type:Individual
Prefix:
First Name:TIJUANA
Middle Name:MCLEOD
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 CLUB HILL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7572
Mailing Address - Country:US
Mailing Address - Phone:919-806-0088
Mailing Address - Fax:
Practice Address - Street 1:9308 CLUB HILL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7572
Practice Address - Country:US
Practice Address - Phone:919-806-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046WHOtherBCBS
NC6107407Medicaid