Provider Demographics
NPI:1114181211
Name:CROUCH, VICTOR LAMONT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:LAMONT
Last Name:CROUCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BRIDGEWATER RD
Mailing Address - Street 2:SUITE G-2
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4767
Mailing Address - Country:US
Mailing Address - Phone:404-229-7933
Mailing Address - Fax:
Practice Address - Street 1:3100 GENTIAN BOULEVARD
Practice Address - Street 2:SUITE 007L
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-8200
Practice Address - Country:US
Practice Address - Phone:404-229-7933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical