Organization
BRIAN CROCKETT COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN CROCKETT MATH, LADC1, CFTP (OWNER, COUNSELOR)
(978) 979-7257
Entity
Organization
Contact information
Practice address
89 MAIN ST STE 304, MILFORD, MA 01757-2600
(978) 536-1056
Mailing address
89 MAIN ST STE 304, MILFORD, MA 01757-2600
(978) 536-1056
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376848309
—
MA
Enumeration date
05/13/2019
Last updated
06/11/2019
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