Crocker, Carrie Caroline

Crocker, Carrie Caroline is an individual health care provider with primary practice located at 2020 Broadway St Suite D, Mount Vernon IL 62864-2973. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Crocker, Carrie Caroline can be contacted via phone (314) 719-6263.

Contact Information

Primary practice address
2020 Broadway St Suite D Mount Vernon IL 62864-2973
Phone: (314) 719-6263
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 2003032196 Missouri
Behavioral Health & Social Service Providers / Clinical 1041C0700X 149016386 Illinois

Profile Details

NPI number 1972657187
LBN Legal business name Crocker, Carrie Caroline
Credentials MSW, LCSW
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2007
Last updated Apr 18th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972657187 NPPES
Missouri MEDICAID 497312108

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