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General NPI Number Information
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NPI Number | 1083068563
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Entity Type | Organization
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Legal Business Name | CROSSROADS CENTER OF FREDERICK LLC
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 1890 N MARKET ST STE 301
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City | FREDERICK
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State | MD
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Zip | 21701-3033
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Country | US
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Telephone | 301-696-1950
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Fax | 301-698-2661
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Provider Business Mailing Address
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Address Line | 1890 N MARKET ST STE 301
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City | FREDERICK
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State | MD
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Zip | 21701-3033
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Country | US
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Telephone | 301-696-1950
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Fax | 301-698-2661
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | CHRISTOPHER GERARD LUECKING
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Credential |
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Telephone | 301-696-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 06287
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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