Provider Demographics
NPI:1982275533
Name:CROWLEY, BROCELYN L
Entity Type:Individual
Prefix:
First Name:BROCELYN
Middle Name:L
Last Name:CROWLEY
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 1:247 SWEET MARTHA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-7906
Mailing Address - Country:US
Mailing Address - Phone:570-772-6020
Mailing Address - Fax:
Practice Address - Street 1:4211 OKEMOS RD STE 18
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3287
Practice Address - Country:US
Practice Address - Phone:313-444-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103565104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty