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General NPI Number Information
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NPI Number | 1992440242
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Entity Type | Organization
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Legal Business Name | CROSSROADS WELLNESS LLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 3302 WASHINGTON BLVD
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City | BALTIMORE
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State | MD
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Zip | 21227-1618
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Country | US
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Telephone | 410-697-5502
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Fax | 410-457-9420
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Provider Business Mailing Address
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Address Line | 17331 BUSHLAND RD
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City | PARKTON
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State | MD
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Zip | 21120-9476
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Country | US
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Telephone | 443-484-6408
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MS. MEGAN JOY DEVAUGHN
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Credential |
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Telephone | 443-484-6408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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