Provider Demographics
NPI:1891989448
Name:CROCHET, MARINDA MADSON (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARINDA
Middle Name:MADSON
Last Name:CROCHET
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WOODTRAIL LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9730
Mailing Address - Country:US
Mailing Address - Phone:704-906-2817
Mailing Address - Fax:
Practice Address - Street 1:DUKE HOSPITAL SOCIAL WORK DEPARTMENT
Practice Address - Street 2:DUMC BOX 3376
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-681-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO45541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106838Medicaid