Provider Demographics
NPI:1881854131
Name:CROSSROADS COUNSELING CENTER
Entity type:Organization
Organization Name:CROSSROADS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-644-0977
Mailing Address - Street 1:4140 OCEANSIDE BLVD
Mailing Address - Street 2:STE 159-112
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6005
Mailing Address - Country:US
Mailing Address - Phone:760-644-0977
Mailing Address - Fax:
Practice Address - Street 1:4140 OCEANSIDE BLVD
Practice Address - Street 2:STE 159-112
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-6005
Practice Address - Country:US
Practice Address - Phone:760-644-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty