Provider Demographics
NPI:1710412200
Name:ROSE, DEIRDRE CROCHEN (LPC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:CROCHEN
Last Name:ROSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CENTURY PARK S
Mailing Address - Street 2:102
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3949
Mailing Address - Country:US
Mailing Address - Phone:888-386-9624
Mailing Address - Fax:888-386-9624
Practice Address - Street 1:100 CENTURY PARK S
Practice Address - Street 2:102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3949
Practice Address - Country:US
Practice Address - Phone:888-386-9624
Practice Address - Fax:888-386-9624
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health