Provider Demographics
NPI:1396595914
Name:CROSBY, SANDRA C
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:CROSBY
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 1:6450 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4882
Mailing Address - Country:US
Mailing Address - Phone:843-818-5100
Mailing Address - Fax:
Practice Address - Street 1:6966 BUCKHORN RD
Practice Address - Street 2:
Practice Address - City:RAVENEL
Practice Address - State:SC
Practice Address - Zip Code:29470-5499
Practice Address - Country:US
Practice Address - Phone:719-641-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker