Provider Demographics
NPI:1518050251
Name:CROFTS, CAROLE ELEANOR (PHD,MS,LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ELEANOR
Last Name:CROFTS
Suffix:
Gender:F
Credentials:PHD,MS,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 SO ASPEN ST.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-0000
Mailing Address - Country:US
Mailing Address - Phone:559-738-0644
Mailing Address - Fax:559-738-0780
Practice Address - Street 1:1212 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-0000
Practice Address - Country:US
Practice Address - Phone:559-738-0644
Practice Address - Fax:559-738-0780
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL142640Medicare PIN