Healthcare Provider Details

I. General information

NPI: 1538083563
Provider Name (Legal Business Name): GRACE ANN HINNANT CROCKER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 ROCKWOOD RD
COLUMBIA SC
29209-2474
US

IV. Provider business mailing address

1265 ROCKWOOD RD
COLUMBIA SC
29209-2474
US

V. Phone/Fax

Practice location:
  • Phone: 803-904-2375
  • Fax:
Mailing address:
  • Phone: 803-904-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberNONE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: