| NPI | 1518226075 |
|---|---|
| Former Legal Business Name | CROSSROADS LAKE COUNTY ADOLESCENT COUNSELING |
| Entity Type | Organization |
| Authorized Contact | MICHAEL MATONEY CEO 440-255-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2021-11-11 |