Individual
DERRICK ALIF CROWLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17 MAIN ST, CORTLAND, NY 13045-6606
(315) 440-6611
Mailing address
17 MAIN ST, SYRACUSE, NY 13209-1810
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25195
NY
Other
Enumeration date
05/13/2011
Last updated
06/03/2014
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