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General NPI Number Information
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NPI Number | 1922372796
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Entity Type | Organization
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Legal Business Name | CROSSROADS COUNSELING & CONSULTATION SERVICES, LLC
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 490 EDWARD ST
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City | MIDDLEVILLE
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State | MI
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Zip | 49333-9131
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Country | US
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Telephone | 616-450-4925
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Fax |
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Provider Business Mailing Address
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Address Line | 490 EDWARD ST
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City | MIDDLEVILLE
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State | MI
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Zip | 49333-9131
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Country | US
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Telephone | 616-450-4925
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Fax |
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Authorized Official
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Title or Position | THERAPIST/MANAGING MEMBER
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Name | MRS. CANDACE A JOHNSON
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Credential | L.M.S.W.
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Telephone | 616-450-4925
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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 | 6801082216
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801082216
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License Number State | MI
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