Provider Demographics
NPI:1700920477
Name:NORMAN A CROOM
Entity Type:Organization
Organization Name:NORMAN A CROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALCOHOL DRUG COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:CROOM
Authorized Official - Suffix:
Authorized Official - Credentials:FACT
Authorized Official - Phone:760-243-1176
Mailing Address - Street 1:2661 CINCINNATI ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407
Mailing Address - Country:US
Mailing Address - Phone:760-955-1777
Mailing Address - Fax:
Practice Address - Street 1:12625 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-243-1176
Practice Address - Fax:760-955-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00339101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty