Provider Demographics
NPI:1386371060
Name:CROSS BEHAVIORAL CONSULTING LLC
Entity type:Organization
Organization Name:CROSS BEHAVIORAL CONSULTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:JOI
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-374-8772
Mailing Address - Street 1:2107 TURLEYGREEN PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8984
Mailing Address - Country:US
Mailing Address - Phone:919-408-4627
Mailing Address - Fax:
Practice Address - Street 1:2670 CRAIN HWY STE 106
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2820
Practice Address - Country:US
Practice Address - Phone:301-374-8772
Practice Address - Fax:301-374-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD999984100Medicaid