Provider Demographics
NPI:1366890840
Name:CROSSROADS COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:CROSSROADS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-327-6633
Mailing Address - Street 1:255 18TH STREET SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1364
Mailing Address - Country:US
Mailing Address - Phone:828-327-6633
Mailing Address - Fax:828-327-3385
Practice Address - Street 1:573 FAIRVIEW RD
Practice Address - Street 2:SUITE 6
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1345
Practice Address - Country:US
Practice Address - Phone:828-327-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSROADS COUNSELING CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-25
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4653101YP2500X
NCC0041151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002334Medicaid
NC6003806Medicaid
NC6102176Medicaid