MEDICARE: MS. DEIRDRE CROCHEN ROSE LPC

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	101YP2500X	Professional Counselor	3708	AL

General Provider Information

NPI Number	:	1710412200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEIRDRE CROCHEN ROSE LPC

Provider Business Mailing Address
First Line	:	400 CENTURY PARK S STE 106
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-3925
Country	:	US
Telephone Number	:	205-739-2145
Fax Number	:	205-606-6494

Provider Business Practice Location Address
First Line	:	400 CENTURY PARK S STE 106
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-3925
Country	:	US
Telephone Number	:	205-739-2145
Fax Number	:	205-606-6494

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

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	09/28/2024

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