Organization
EDGEWOOD GROUP FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TRAVIS CROCKER (DIRECTOR OF SERVICES)
(804) 648-0671
Entity
Organization
Contact information
Practice address
4906 FITZHUGH AVE, SUITE 104, RICHMOND, VA 23230-3526
(804) 648-0671
(804) 648-0672
Mailing address
4906 FITZHUGH AVE, SUITE 104, RICHMOND, VA 23230-3526
(804) 648-0671
(804) 648-0672
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
709-05-001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010127394
—
VA
Enumeration date
08/14/2006
Last updated
02/17/2011
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