Organization
CROSSROADS GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DORELLA LOUISE BOND PH.D. (MEMBER/OWNER)
(734) 660-4828
Entity
Organization
Contact information
Practice address
667 KUEHNLE ST, ANN ARBOR, MI 48103-2608
(734) 660-4828
(734) 994-9722
Mailing address
667 KUEHNLE ST, ANN ARBOR, MI 48103-2608
(734) 660-4828
(734) 994-9722
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301012697
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060001850CT01
BC/BS OF CT
CT
01
—
1780613885
INDIVIDUAL NPI
MI
01
—
68-0-F3-3231-0
BC/BS OF MI
MI
Enumeration date
09/20/2006
Last updated
07/16/2008
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