Provider Demographics
NPI:1104081603
Name:CROSS, WESLEY LLOYD (LMSW)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:LLOYD
Last Name:CROSS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S LINDEN RD
Mailing Address - Street 2:SUITE D-128
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5473
Mailing Address - Country:US
Mailing Address - Phone:810-618-1904
Mailing Address - Fax:
Practice Address - Street 1:2425 S LINDEN RD
Practice Address - Street 2:SUITE D-128
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5473
Practice Address - Country:US
Practice Address - Phone:810-618-1904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010839941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical