Provider Demographics
NPI:1932380508
Name:CROTTY, JANET RENEE (NCLPC, NBCC)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:RENEE
Last Name:CROTTY
Suffix:
Gender:F
Credentials:NCLPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 OLD CASTLE DR.
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-8312
Mailing Address - Country:US
Mailing Address - Phone:336-498-7322
Mailing Address - Fax:
Practice Address - Street 1:619 OLD CASTLE DR.
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-8312
Practice Address - Country:US
Practice Address - Phone:336-498-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4334101Y00000X
NC81546101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC81546OtherNBCC
NC4334OtherNCLPC