Provider Demographics
NPI:1003415886
Name:CRENSHAW, TITONI LEVON (QMHP, CSAC)
Entity Type:Individual
Prefix:
First Name:TITONI
Middle Name:LEVON
Last Name:CRENSHAW
Suffix:
Gender:M
Credentials:QMHP, CSAC
Other - Prefix:
Other - First Name:TITONI
Other - Middle Name:LEVON
Other - Last Name:CRENSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHP, CSAC
Mailing Address - Street 1:6985 HEARTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-2663
Mailing Address - Country:US
Mailing Address - Phone:804-712-3546
Mailing Address - Fax:
Practice Address - Street 1:2825 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2473
Practice Address - Country:US
Practice Address - Phone:804-712-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)