Provider Demographics
NPI:1225194004
Name:CROSS ROADS RECONCILIATION SERVICES
Entity type:Organization
Organization Name:CROSS ROADS RECONCILIATION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:D MIN
Authorized Official - Phone:434-791-2767
Mailing Address - Street 1:625 PINEY FOREST RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2867
Mailing Address - Country:US
Mailing Address - Phone:434-791-2767
Mailing Address - Fax:434-791-4944
Practice Address - Street 1:625 PINEY FOREST RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2867
Practice Address - Country:US
Practice Address - Phone:434-791-2767
Practice Address - Fax:434-791-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCU74420101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty