Individual
AUDREY CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(865) 228-9412
Mailing address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(865) 228-9412
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LGP5888
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LGP5888
LGPC
MD
Enumeration date
02/24/2015
Last updated
02/24/2015
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