CARL CROCKETT


Address: 4875 Coplin, Administration, Detroit, MI 48125-2192
Phone: 3138221148

CARL CROCKETT (NPI# 1912025586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1912025586
Entity Type Individual
Full Name CARL CROCKETT
Credential M.A
Practice Address 4875 Coplin
Administration
Detroit
MI 48125-2192
Practice Telephone 3138221148
Practice Fax Number 3138221157
Mailing Telephone 3138221148
Mailing Fax Number 3138221157
Enumeration Date 2007-03-26
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
MA MI Behavioral Health & Social Service Providers

Office Location

Street Address 4875 COPLIN
ADMINISTRATION
City DETROIT
State MI
Zip Code 48125-2192

Providers in the same location

NPI Name Taxonomy Address Enumeration
1033655618 Marquise Kirk Counselor 4875 Coplin, Detroit, MI 48215-2192 2017-01-06

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1063071637 Smart Rx LLC Pharmacy 25464 Van Born Rd, Dearborn Heights, MI 48125 2019-06-07
1558811331 Jacquelyn Elyoussef Technician, Other 3930 Academy St, Dearborn Heights, MI 48125 2016-10-05
1386856375 Amerigard Development Corporation Family Medicine 23850 Van Born Road, Dearborn Heights, MI 48125 2007-05-04
1922140490 Marie C Petricca Social Worker 20382 Van Born Road, Catholic Social Services of Wayne County, Dearborn Heights, MI 48125 2007-02-13
1528025871 David L Cooley Family Medicine 3902 Monroe, Dearborn Heights, MI 48125 2006-04-28
1013998251 Masha-moss Inc Pharmacy 4245 S Beech Daly Rd, Dearborn Heights, MI 48125 2005-11-06
1033639109 Clinic Rx 2 LLC Pharmacy 23850 Van Born Rd, Dearborn Heights, MI 48125 2017-06-21
1932639176 Olivia J. Furnas Midwife 18101 Oakwood Blvd, Dearborn, MI 48125 2017-06-19
1083099303 Holistic Healer Health Coaching LLC Nutritionist 3998 Clippert St, Dearborn Heights, MI 48125 2015-07-28
1396255915 Lillian Drushelia Herzberg Registered Nurse 26827 Annapolis St, Dearborn Hts, MI 48125-1201 2017-10-10
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Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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1750907853 Ronnie Stephen Counselor 15025 Fenkell St, Detroit, MI 48227-2647 2020-06-24
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1396309878 Darnesha Coy Counselor 17870 Dresden St, Detroit, MI 48205-3138 2019-04-30
1518438746 Curron Thomas Counselor 16850 Wyoming St, Apartment 328, Detroit, MI 48221-3415 2018-12-16
1861962094 Reid Talley Counselor 12010 Elmhurst, Detroit, MI 48206 2018-11-30
1205304359 Life Challenge of Southeastern Michigan Counselor 17667 Pierson St, Detroit, MI 48219-2520 2018-11-07
1598233892 Michigan Employment & Training Plus Counselor 6522 Piedmont St, Detroit, MI 48228-4950 2018-11-05
1821588773 Avery Brown Jr. Counselor 8333 Townsend St, Detroit, MI 48213-2331 2018-05-16
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Competitor

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City DETROIT
Zip Code 48125

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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