Individual
MR. CHARLES BURLESON CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1050 RIBAUT RD, BEAUFORT, SC 29902-5400
(843) 524-3379
Mailing address
1050 RIBAUT RD, BEAUFORT, SC 29902-5400
(843) 524-3379
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609963453
—
SC
Enumeration date
10/05/2006
Last updated
10/07/2010
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