Provider Demographics
NPI:1811436843
Name:CROCKER-UNDERWOOD, EMILY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:CROCKER-UNDERWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 GOLF ACRES DR
Mailing Address - Street 2:BUILDING O
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5966
Mailing Address - Country:US
Mailing Address - Phone:704-512-5124
Mailing Address - Fax:704-446-4161
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:980-487-3724
Practice Address - Fax:980-487-3171
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0097141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical