Organization Name: | WANDA A. CROCKETT PLLC |
NPI Number: | 1477675064 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WANDA A. CROCKETT (OWNER) |
Mailing Address: | 1480 Oak Bridge Ct Powhatan |
State: | VA US |
Postal Code: | 231398054 |
Phone Number: | 8044231389 |
Fax Number: | |
NPI Enumeration Date: | 04/04/2007 |
NPI Last Update Date: | 11/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |