Healthcare Provider Details

I. General information

NPI: 1689561573
Provider Name (Legal Business Name): FELICIA ADELE CROCKETT LMSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 PERKINS LN
JACKSBORO TN
37757-2833
US

IV. Provider business mailing address

120 CROCKETT RD
HARROGATE TN
37752-5512
US

V. Phone/Fax

Practice location:
  • Phone: 877-848-9810
  • Fax:
Mailing address:
  • Phone: 423-300-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number260242
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16116
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: