Provider Demographics
NPI:1013419803
Name:CRAWFORD, SHARITA VIVIAN
Entity Type:Individual
Prefix:MRS
First Name:SHARITA
Middle Name:VIVIAN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHARITA
Other - Middle Name:VIVIAN
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8270 WILLOW OAKS CORPORATE DRIVE
Mailing Address - Street 2:OFFICE OF SOCIAL WORK
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DRIVE
Practice Address - Street 2:OFFICE OF SOCIAL WORK
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-718-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS06050161041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool