Provider Demographics
NPI:1700826062
Name:CROOKS, THOMAS ARCHER (LCWS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ARCHER
Last Name:CROOKS
Suffix:
Gender:M
Credentials:LCWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SOUTHCREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-6809
Mailing Address - Country:US
Mailing Address - Phone:804-926-1141
Mailing Address - Fax:
Practice Address - Street 1:3660 BOULEVARD
Practice Address - Street 2:COLONIAL HEIGHTS COUNSELING CENTER SUITE A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1345
Practice Address - Country:US
Practice Address - Phone:804-520-7210
Practice Address - Fax:804-520-8953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005171104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192146Medicaid
VA386400Medicaid