Provider Demographics
NPI:1487011755
Name:CROSSROADS FAMILY COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:CROSSROADS FAMILY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, RPT/S
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MITSCHELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-380-9045
Mailing Address - Street 1:3611 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3246
Mailing Address - Country:US
Mailing Address - Phone:703-380-9045
Mailing Address - Fax:703-261-6980
Practice Address - Street 1:3611 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3246
Practice Address - Country:US
Practice Address - Phone:703-380-9045
Practice Address - Fax:703-261-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty