Organization
CROSSROADS SERVICES BOARD
Active
Organization
CROSSROADS SERVICES BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE FOORE (CREDENTIALING COORDINATOR)
(434) 392-7049
Entity
Organization
Contact information
Practice address
60 BUSH RIVER DRIVE, FARMVILLE, VA 23901
(434) 392-7049
(434) 392-9221
Mailing address
P.O. DRAWER 248, FARMVILLE, VA 23901
(434) 392-7049
(434) 392-9221
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945450
—
VA
Enumeration date
07/08/2006
Last updated
11/09/2020
Update your record
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