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NPI Code Detail

MEDICARE: SANDRA GAIL CROCKER LPC, CSAC, CRC

MEDICARE: SANDRA GAIL CROCKER LPC, CSAC, CRC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor0710102955VA
2225C00000XRehabilitation Counselor00116571VA
3101Y00000XCounselor0701007231VA

General Provider Information

NPI Number : 1417462052
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA GAIL CROCKER LPC, CSAC, CRC
Provider Business Mailing Address
First Line : 9609 JEFFERSON DAVIS HWY
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23237-4621
Country : US
Telephone Number : 804-275-1116
Fax Number : 804-275-1850
Provider Business Practice Location Address
First Line : 9609 JEFFERSON DAVIS HWY
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23237-4621
Country : US
Telephone Number : 804-275-1116
Fax Number : 804-275-1850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2017
Last Update Date : 12/05/2017

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