Healthcare Provider Details

I. General information

NPI: 1750904579
Provider Name (Legal Business Name): CAROLINE NOEL CRILLEY M.S.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 WILLOWSHIRE CT
WAYNESBORO VA
22980-1876
US

IV. Provider business mailing address

416 WILLOWSHIRE CT
WAYNESBORO VA
22980-1876
US

V. Phone/Fax

Practice location:
  • Phone: 571-358-9550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704011155
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: