Healthcare Provider Details

I. General information

NPI: 1487011755
Provider Name (Legal Business Name): CROSSROADS FAMILY COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 CHAIN BRIDGE RD SUITE C
FAIRFAX VA
22030-3246
US

IV. Provider business mailing address

3611 CHAIN BRIDGE RD SUITE C
FAIRFAX VA
22030-3246
US

V. Phone/Fax

Practice location:
  • Phone: 703-380-9045
  • Fax: 703-261-6980
Mailing address:
  • Phone: 703-380-9045
  • Fax: 703-261-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHERI MITSCHELEN
Title or Position: LCSW, RPT/S
Credential:
Phone: 703-380-9045