Provider Demographics
NPI:1710064134
Name:MCCROSSIN, TERESA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:MCCROSSIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 CENTRAL PARK BLVD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4942
Mailing Address - Country:US
Mailing Address - Phone:540-785-1660
Mailing Address - Fax:866-736-3024
Practice Address - Street 1:1320 CENTRAL PARK BLVD
Practice Address - Street 2:SUITE 231
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4942
Practice Address - Country:US
Practice Address - Phone:540-785-1660
Practice Address - Fax:866-736-3024
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA80002867Medicare ID - Type Unspecified