Provider Demographics
NPI:1033322037
Name:CROSBY, MICHAEL WOLFERTH (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WOLFERTH
Last Name:CROSBY
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4864 TURKEY SAG RD
Mailing Address - Street 2:
Mailing Address - City:KESWICK
Mailing Address - State:VA
Mailing Address - Zip Code:22947-1601
Mailing Address - Country:US
Mailing Address - Phone:434-973-1655
Mailing Address - Fax:
Practice Address - Street 1:198 SPOTNAP RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8614
Practice Address - Country:US
Practice Address - Phone:434-295-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040036871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical