Healthcare Provider Details

I. General information

NPI: 1710895909
Provider Name (Legal Business Name): CROCUS MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 AMERICANA DR APT 207
ANNANDALE VA
22003-5018
US

IV. Provider business mailing address

4917 AMERICANA DR APT 207
ANNANDALE VA
22003-5018
US

V. Phone/Fax

Practice location:
  • Phone: 817-842-4302
  • Fax:
Mailing address:
  • Phone: 817-779-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CARISSA HOTELLING
Title or Position: OWNER/AUTHORIZEDOFFICIAL
Credential: LCSW
Phone: 817-842-4302