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General NPI Number Information
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NPI Number | 1114431863
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Entity Type | Individual
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Provider Name | CHANTEL CROCKETT LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 2351 ENERGY DR STE 1100
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City | BATON ROUGE
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State | LA
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Zip | 70808-2617
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Country | US
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Telephone | 225-465-3080
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Fax | 225-465-3706
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Provider Business Mailing Address
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Address Line | 2376 CREEK HOLLOW AVE
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City | ZACHARY
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State | LA
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Zip | 70791-2895
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Country | US
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Telephone | 225-218-7472
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Fax | 225-465-3706
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15883
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License Number State | LA
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