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General NPI Number Information
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NPI Number | 1477675064
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Entity Type | Organization
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Legal Business Name | WANDA A. CROCKETT PLLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 1480 OAK BRIDGE CT
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City | POWHATAN
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State | VA
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Zip | 23139-8054
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Country | US
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Telephone | 804-423-1389
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 GADWELL TER
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City | CHESTERFIELD
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State | VA
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Zip | 23838-5215
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Country | US
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Telephone | 804-748-4774
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. WANDA A. CROCKETT
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Credential | L.P.C.
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Telephone | 804-748-4774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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