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General NPI Number Information
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NPI Number | 1629497300
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Entity Type | Organization
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Legal Business Name | CROSSROADS THERAPY LLC
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 3440 TORINGDON WAY SUITE 205
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City | CHARLOTTE
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State | NC
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Zip | 28277-3190
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Country | US
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Telephone | 704-325-5850
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Fax | 704-585-1086
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Provider Business Mailing Address
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Address Line | 3440 TORINGDON WAY SUITE 205
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City | CHARLOTTE
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State | NC
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Zip | 28277-3190
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Country | US
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Telephone | 704-325-5850
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Fax | 704-585-1086
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. SHIRLEY HIJIN BROWN
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Credential | LCSW
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Telephone | 704-877-8655
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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 | C006772
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006866
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C005971
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License Number State | NC
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