Healthcare Provider Details

I. General information

NPI: 1699548610
Provider Name (Legal Business Name): TERRA ALYSSA CROWL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRA ALYSSA CROWL LCSW

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 06/30/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 510-631-9285
  • Fax:
Mailing address:
  • Phone: 510-631-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: