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General NPI Number Information
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NPI Number | 1841735750
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Entity Type | Organization
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Legal Business Name | CROSSROADS ADDICTION SERVICES, INC
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Dates
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Enumeration Date | 12/31/2016
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 1420 SW SAINT LUCIE WEST BLVD STE 106
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1709
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Country | US
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Telephone | 772-242-5408
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 SW SAINT LUCIE WEST BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1709
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Country | US
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Telephone | 772-242-5408
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. THERESA A BIEMER
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Credential | PA-C
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Telephone | 772-242-5408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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