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General NPI Number Information
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NPI Number | 1689561573
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Entity Type | Individual
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Provider Name | FELICIA ADELE CROCKETT LMSW, CSW
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Gender | Female
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 114 PERKINS LN
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City | JACKSBORO
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State | TN
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Zip | 37757-2833
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Country | US
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Telephone | 877-848-9810
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CROCKETT RD
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City | HARROGATE
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State | TN
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Zip | 37752-5512
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Country | US
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Telephone | 423-300-0594
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 260242
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 16116
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License Number State | TN
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