Individual
ANGELA CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
4061 SUZANNE DR # C, DIBERVILLE, MS 39540-3735
(228) 396-4434
Mailing address
4061 SUZANNE DR # C, DIBERVILLE, MS 39540-3735
(228) 396-4434
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-68941
MS
Other
Enumeration date
07/10/2019
Last updated
12/01/2023
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