Crossroads Church of Douglasville

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005316 Issued in GA

Legal business name

CROSSROADS CHURCH OF DOUGLASVILLE

Practice address

5960 Stewart Pkwy
Douglasville, GA 30135-2372

Phone

(404) 996-0170

NPI assigned

Nov 13, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin McKinney, L.C.S.W.NPI 1346646627

Title

Director of Counseling

Phone

(404) 996-0170

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin McKinney, L.C.S.W.

  • Clinical Social Worker
  • Carrollton, GA
  • NPI 1346646627
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415836800000",
    "number": "1265838544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5960 STEWART PKWY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352372",
            "telephone_number": "404-996-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5960 STEWART PKWY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352372",
            "telephone_number": "404-996-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS CHURCH OF DOUGLASVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-13",
        "last_updated": "2014-11-13",
        "status": "A",
        "authorized_official_last_name": "MCKINNEY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "DIRECTOR OF COUNSELING",
        "authorized_official_telephone_number": "404-996-0170",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC003962",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laveta Crawford
• Morgan Crawford
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• Crew LLC
• Shanessa Crook, LPC
• Roy Ervin Crowe Jr., D.D.S.P.C.
• Jennifer Ann Crumbley-Dodson, PSY.D.
• Alan Jay Crumpler, D.C.
• Crums a-1 Transport LLC
• Fatima Lisseth Cruz Portillo, DC

• Clinical Social Worker in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.