Healthcare Provider Details

I. General information

NPI: 1376478784
Provider Name (Legal Business Name): CALLIE DANIELLE CROCKER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CALLIE DANIELLE BAUCOM BCBA

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 ALEXWOOD DR
HOPE MILLS NC
28348-5600
US

IV. Provider business mailing address

1044 ALEXWOOD DR
HOPE MILLS NC
28348-5600
US

V. Phone/Fax

Practice location:
  • Phone: 704-690-0472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1091672
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: