Healthcare Provider Details

I. General information

NPI: 1396015038
Provider Name (Legal Business Name): CROSSROADS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 MAIN ST STE 201
METUCHEN NJ
08840-1960
US

IV. Provider business mailing address

402 MAIN ST STE 201
METUCHEN NJ
08840-1960
US

V. Phone/Fax

Practice location:
  • Phone: 732-635-9797
  • Fax:
Mailing address:
  • Phone: 732-635-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MISS JACQUELINE MARIE GIORDANO
Title or Position: OWNER
Credential: LPC
Phone: 732-635-9797