MEDICARE: CALLIE DANIELLE CROCKER BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BACB1091672	NC

General Provider Information

NPI Number	:	1376478784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLIE DANIELLE CROCKER BCBA

Provider Business Mailing Address
First Line	:	1044 ALEXWOOD DR
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-5600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1044 ALEXWOOD DR
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-5600
Country	:	US
Telephone Number	:	704-690-0472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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