Healthcare Provider Details

I. General information

NPI: 1518603018
Provider Name (Legal Business Name): CROSSING WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2022
Last Update Date: 05/08/2022
Certification Date: 05/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MILYKO DR
WASHINGTON CROSSING PA
18977-1039
US

IV. Provider business mailing address

1077 RIVER RD UNIT 81
WASHINGTON CROSSING PA
18977-2205
US

V. Phone/Fax

Practice location:
  • Phone: 215-932-0555
  • Fax:
Mailing address:
  • Phone: 215-932-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. CASSANDRA CRAWFORD GIBSON
Title or Position: PRINCIPAL
Credential: PHD, LCSW, LCADC
Phone: 215-932-0555