Dynamic Counseling and Consultation Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2003032196 Issued in MO

Legal business name

DYNAMIC COUNSELING AND CONSULTATION SERVICES

Practice address

4202 Williamson PL Ste 1
Mount Vernon, IL 62864-6760

Phone

(618) 816-1224

Fax

(800) 335-4761

NPI assigned

Apr 27, 2014

Last updated

Jan 27, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Carrie Crocker, LCSWNPI 1972657187

Title

Owner

Phone

(618) 816-1224

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carrie Caroline Crocker, MSW, LCSW

  • Clinical Social Worker
  • Mount Vernon, IL
  • NPI 1972657187
  Medicare reassignment Care Compare group NPD Authorized official
• Tiffany Nicole Shurtz, MSW, LCSW

  • Clinical Social Worker
  • Du Quin, IL
  • NPI 1467112417
  Medicare reassignment Care Compare group NPD
• Tiffany Blasdel

  • Social Worker
  • Wayne City, IL
  • NPI 1376234831
  Medicare reassignment Care Compare group
• Raquel Pulliam

  • Social Worker
  • Mount Vernon, IL
  • NPI 1669152450
  NPD (past)
• Amber Phelps Schweda, LCPC

  • Professional Counselor
  • Mount Vernon, IL
  • NPI 1326470121
  NPD (past)
• Tamika Butler, LPC

  • Professional Counselor
  • Saint Louis, MO
  • NPI 1730482266
  NPD (past)
• Laura Michelle McClure

  • Clinical Social Worker
  • Desloge, MO
  • NPI 1154858660
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1457771677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 S LINCOLN AVE UNIT 1326",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622695165",
            "telephone_number": "618-816-1224",
            "fax_number": "800-335-4761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 WILLIAMSON PL STE 1",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646760",
            "telephone_number": "618-816-1224",
            "fax_number": "800-335-4761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC COUNSELING AND CONSULTATION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-816-1224",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2003032196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "497312108",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley Ray Drake
• Alyssa Sabree Dudley, MSN, RN
• Tom Andrew Duff, LCSW
• Valerie Duff, LCSW
• Anna Dukes, LMSW
• Amber Dove Easley
• Naomi D Easley, LPN
• George C Edwards, HIS
• Elizabeth Eggemeyer, CRNA
• Egyptian Spine Clinic

• Clinical Social Worker in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.