Provider Demographics
NPI:1629132188
Name:CROCKFORD, LORRAINE (MFT)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:CROCKFORD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:CROCKFORD
Other - Last Name:EHRENCLOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:2261 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3721
Mailing Address - Country:US
Mailing Address - Phone:707-259-8169
Mailing Address - Fax:707-259-8651
Practice Address - Street 1:2261 ELM ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3721
Practice Address - Country:US
Practice Address - Phone:707-259-8169
Practice Address - Fax:707-259-8651
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist