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General NPI Number Information
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NPI Number | 1902565740
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Entity Type | Organization
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Legal Business Name | CROSSROADS HEALING AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 4315 RIDGEWOOD CENTER DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5308
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Country | US
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Telephone | 703-580-1141
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Fax | 703-580-1132
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Provider Business Mailing Address
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Address Line | 4315 RIDGEWOOD CENTER DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5308
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Country | US
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Telephone | 703-580-1141
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Fax | 703-580-1132
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | JOANNA PIERCE
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Credential | MA, LPC
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Telephone | 703-580-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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