Organization
SOUTHERN CROSS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM DALE HUDSON OWNER (OWNER)
(910) 653-2007
Entity
Organization
Contact information
Practice address
4705 SOUTHPORT ROAD SE, SUITE 108, SOUTHPORT, NC 28461-9074
(910) 457-6086
(910) 487-6089
Mailing address
PO BOX 656, TABOR CITY, NC 28463-0656
(910) 653-2007
(910) 653-5222
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TH0100X
Health Service Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
11/20/2007
Last updated
11/20/2007
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