NPIMap

Organization Active NPI

Edgewood Group Family Services

  • Addiction (Substance Use Disorder) Counselor
  • Petersburg, VA
National Provider Identifier
1679195895
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
EDGEWOOD GROUP FAMILY SERVICES
Practice address
135 S Adams St
Petersburg, VA 23803-4526
Phone
(804) 912-8622
NPI assigned
May 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
William Travis Crocker
Title
Owner
Phone
(804) 356-4766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary

Addresses

Primary practice location

135 S Adams St
Petersburg, VA 23803-4526

Mailing address

135 S Adams St
Petersburg, VA 23803-4526
Phone (804) 912-8622

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Edgewoodgroup@aol.com

National Provider Directory

National Provider Directory
Tax ID family
Edgewood Group Family Services24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1679195895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 S ADAMS ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034526",
            "telephone_number": "804-912-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 S ADAMS ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034526",
            "telephone_number": "804-912-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD GROUP FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-356-4766"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Edgewoodgroup@aol.com",
            "affiliation": "N",
            "address_1": "135 S Adams St",
            "city": "Petersburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "238034526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.