Individual
KAVONNE CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 S 28TH ST # 1, LINCOLN, NE 68510-1319
(402) 805-2552
Mailing address
120 S 28TH ST # 1, LINCOLN, NE 68510-1319
(402) 805-2552
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
NE
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/11/2022
Last updated
01/16/2026
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