Individual
AINIGRIV CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
8894 STANFORD BLVD, COLUMBIA, MD 21045-4794
(240) 839-1361
Mailing address
8894 STANFORD BLVD STE 103, COLUMBIA, MD 21045-5161
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC12104
MD
101YM0800X
Mental Health Counselor
LGP10310
MD
Other
Enumeration date
10/22/2021
Last updated
08/15/2023
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