Provider Demographics
NPI:1417388372
Name:CROSSROADS CREATIVE COUNSELING
Entity type:Organization
Organization Name:CROSSROADS CREATIVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHERER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-223-2464
Mailing Address - Street 1:23680 THREE NOTCH RD # 202B
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-3085
Mailing Address - Country:US
Mailing Address - Phone:240-223-2464
Mailing Address - Fax:240-718-1708
Practice Address - Street 1:23680 THREE NOTCH RD # 202B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-3085
Practice Address - Country:US
Practice Address - Phone:240-223-2464
Practice Address - Fax:240-718-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5145101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty