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General NPI Number Information
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NPI Number | 1881854131
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Entity Type | Organization
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Legal Business Name | CROSSROADS COUNSELING CENTER
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 4140 OCEANSIDE BLVD STE 159-112
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City | OCEANSIDE
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State | CA
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Zip | 92056-6005
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Country | US
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Telephone | 760-644-0977
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Fax |
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Provider Business Mailing Address
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Address Line | 4140 OCEANSIDE BLVD STE 159-112
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City | OCEANSIDE
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State | CA
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Zip | 92056-6005
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Country | US
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Telephone | 760-644-0977
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JOSEPH B. KENNEDY SR.
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Credential | PH.D.
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Telephone | 760-644-0977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 712
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License Number State | CA
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