Provider Demographics
NPI:1770652109
Name:CROCKETT, ANNE K (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:K
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40406
Mailing Address - Street 2:CENTERSTONE ASSOC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204
Mailing Address - Country:US
Mailing Address - Phone:615-463-6600
Mailing Address - Fax:615-463-6603
Practice Address - Street 1:801 SCHOOL ST BOX 598
Practice Address - Street 2:CENTERSTONE ASSOC
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38402-0598
Practice Address - Country:US
Practice Address - Phone:931-490-1460
Practice Address - Fax:931-490-1472
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000032581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3696954Medicaid
TN3696954Medicaid