Crockett, Theresa

Crockett, Theresa is an individual health care provider with primary practice located at 1543 Kingsley Ave Suite 18A, Orange Park FL 32073-4535. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Crockett, Theresa can be contacted via phone (904) 269-3324.

Contact Information

Primary practice address
1543 Kingsley Ave Suite 18A Orange Park FL 32073-4535
Phone: (904) 269-3324
Fax: (904) 264-2302
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH5726 Florida

Profile Details

NPI number 1164571683
LBN Legal business name Crockett, Theresa
Credentials L.M.H.C.
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 10th, 2007
Last updated May 16th, 2012 - about 12 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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