MEDICARE: CROSSBEAM COUNSELING CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YP2500X	Professional Counselor	NC
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	163WP0808X	Psychiatric/Mental Health Registered Nurse
5	2084P0800X	Psychiatry Physician
6	225700000X	Massage Therapist
7	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
8	261QM0855X	Adolescent and Children Mental Health Clinic/Center
9	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	507481	OTHER	NC	TRICARE
2	846813	OTHER	NC	MILITARY ONE SOURCE
3	507481	OTHER	NC	MHN
4	846813	OTHER	NC	BEACON/VALUE OPTIONS

General Provider Information

NPI Number	:	1689183493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSBEAM COUNSELING CENTERS

Provider Business Mailing Address
First Line	:	1017 HOPE MILLS RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4234
Country	:	US
Telephone Number	:	910-491-6011
Fax Number	:	910-491-6967

Provider Business Practice Location Address
First Line	:	1017 HOPE MILLS RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4234
Country	:	US
Telephone Number	:	910-491-6011
Fax Number	:	910-491-6967

Authorized Official
Title or Position	:	LPC/OWNER
Name	:	MRS. DEANGELA CHRISTINE GEE
Credential	:	LPC
Telephone Number	:	910-491-6011

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	07/21/2022

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Practice Location Address:

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