| Doctor Name: | MS. STEPHANY ANNE COCKRUM |
| NPI Number: | 1245657329 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 12114 |
| Business Practice Address: | 576 Jefferson Ave Fort Eustis, VA - 236041373 |
| Business Phone Number: | 7573147500 |
| Business Fax Number: | 7573147854 |
| Mailing Address: | 505 Schooner Blvd, WILLIAMSBURG |
| State: | VA |
| Postal Code: | 231855277 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/26/2014 |
| NPI Last Update Date: | 03/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 12114 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |