Provider Demographics
NPI:1003011420
Name:CRAWFORD, CELESTE S (MS)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:S
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 W RAGSDALE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4716
Mailing Address - Country:US
Mailing Address - Phone:252-341-8233
Mailing Address - Fax:
Practice Address - Street 1:1309 W RAGSDALE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4716
Practice Address - Country:US
Practice Address - Phone:252-341-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103175Medicaid