Provider Demographics
NPI:1548690142
Name:CROSS ROADS RECONCILIATION SERVICES, LLC
Entity type:Organization
Organization Name:CROSS ROADS RECONCILIATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-791-2767
Mailing Address - Street 1:625 PINEY FOREST RD STE 108
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2846
Mailing Address - Country:US
Mailing Address - Phone:434-791-2767
Mailing Address - Fax:434-791-4944
Practice Address - Street 1:625 PINEY FOREST RD STE 108
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2846
Practice Address - Country:US
Practice Address - Phone:434-791-2767
Practice Address - Fax:434-791-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACU74420101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty