Healthcare Provider Details

I. General information

NPI: 1386371060
Provider Name (Legal Business Name): CROSS BEHAVIORAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY STE 106
WALDORF MD
20601-2820
US

IV. Provider business mailing address

2107 TURLEYGREEN PL
UPPER MARLBORO MD
20774-8984
US

V. Phone/Fax

Practice location:
  • Phone: 301-374-8772
  • Fax: 301-374-8773
Mailing address:
  • Phone: 919-408-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EBONY JOI CROSS
Title or Position: MEDICAL DIRECTOR
Credential: NP
Phone: 301-374-8772