Individual
AUDRA RENEE CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RADT
Contact information
Practice address
750 SPAANS DR STE C, GALT, CA 95632-8609
(209) 744-9909
(209) 744-9910
Mailing address
750 SPAANS DR STE C, GALT, CA 95632-8609
(209) 744-9909
(209) 744-8810
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1429190521
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912277492
—
CA
Enumeration date
05/13/2021
Last updated
05/13/2021
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