Provider Demographics
NPI:1982887501
Name:CROSS ROADS COUNSELING, LLC
Entity Type:Organization
Organization Name:CROSS ROADS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-740-2644
Mailing Address - Street 1:246 FEDERAL RD
Mailing Address - Street 2:UNIT C-33
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2647
Mailing Address - Country:US
Mailing Address - Phone:203-740-2644
Mailing Address - Fax:203-740-7887
Practice Address - Street 1:246 FEDERAL RD
Practice Address - Street 2:UNIT C-33
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2647
Practice Address - Country:US
Practice Address - Phone:203-740-2644
Practice Address - Fax:203-740-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03053Medicare PIN