Provider Demographics
NPI:1962716308
Name:CROSS ROADS PROFESSIONAL COUNSELING
Entity type:Organization
Organization Name:CROSS ROADS PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LPC/MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TABRINA
Authorized Official - Middle Name:LA SHAWN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-649-8263
Mailing Address - Street 1:PO BOX 972843
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-0323
Mailing Address - Country:US
Mailing Address - Phone:734-649-8263
Mailing Address - Fax:734-619-6554
Practice Address - Street 1:3362 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3216
Practice Address - Country:US
Practice Address - Phone:734-649-8263
Practice Address - Fax:734-619-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty