Organization
EDGEWOOD GROUP FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TRAVIS CROCKER (OWNER)
(804) 356-4766
Entity
Organization
Contact information
Practice address
135 S ADAMS ST, PETERSBURG, VA 23803-4526
(804) 912-8622
Mailing address
135 S ADAMS ST, PETERSBURG, VA 23803-4526
(804) 912-8622
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/11/2020
Last updated
05/11/2020
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