Healthcare Provider Details

I. General information

NPI: 1548690142
Provider Name (Legal Business Name): CROSS ROADS RECONCILIATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 PINEY FOREST RD STE 108
DANVILLE VA
24540-2846
US

IV. Provider business mailing address

625 PINEY FOREST RD STE 108
DANVILLE VA
24540-2846
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-2767
  • Fax: 434-791-4944
Mailing address:
  • Phone: 434-791-2767
  • Fax: 434-791-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberCU74420
License Number StateVA

VIII. Authorized Official

Name: DR. REGINA CURTIS
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 434-791-2767