Provider Demographics
NPI:1912376815
Name:CROCKER, KAMARY
Entity Type:Individual
Prefix:
First Name:KAMARY
Middle Name:
Last Name:CROCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7833 EMBER CREST TRL
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-3404
Mailing Address - Country:US
Mailing Address - Phone:865-201-1717
Mailing Address - Fax:
Practice Address - Street 1:7833 EMBER CREST TRL
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-3404
Practice Address - Country:US
Practice Address - Phone:865-201-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional