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General NPI Number Information
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NPI Number | 1487011755
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Entity Type | Organization
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Legal Business Name | CROSSROADS FAMILY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 01/18/2016
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Provider Practice Location Address
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Address Line | 3611 CHAIN BRIDGE RD SUITE C
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City | FAIRFAX
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State | VA
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Zip | 22030-3246
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Country | US
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Telephone | 703-380-9045
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Fax | 703-261-6980
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Provider Business Mailing Address
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Address Line | 3611 CHAIN BRIDGE RD SUITE C
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City | FAIRFAX
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State | VA
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Zip | 22030-3246
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Country | US
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Telephone | 703-380-9045
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Fax | 703-261-6980
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Authorized Official
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Title or Position | LCSW, RPT/S
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Name | SHERI MITSCHELEN
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Credential |
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Telephone | 703-380-9045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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