Provider Demographics
NPI:1184954380
Name:CROCKETT, NANCY DENISE K (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY DENISE
Middle Name:K
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4516
Mailing Address - Country:US
Mailing Address - Phone:864-313-6530
Mailing Address - Fax:864-968-9449
Practice Address - Street 1:311 BENNETT CENTER DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1259
Practice Address - Country:US
Practice Address - Phone:864-968-9687
Practice Address - Fax:864-968-9449
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional