| Edgewood Group Family Services | |
|
135 S Adams St Petersburg VA 23803-4526 | |
| (804) 912-8622 | |
| Not Available |
| Full Name | Edgewood Group Family Services |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 135 S Adams St, Petersburg, Virginia |
| Authorized Official Name and Position | William Travis Crocker (OWNER) |
| Authorized Official Contact | 8043564766 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewood Group Family Services 135 S Adams St Petersburg VA 23803-4526 Ph: (804) 912-8622 | Edgewood Group Family Services 135 S Adams St Petersburg VA 23803-4526 Ph: (804) 912-8622 |
| NPI Number | 1679195895 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 05/11/2020 |
| Certification Date | 05/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679195895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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