Provider Demographics
NPI:1063664332
Name:CRAWFORD, STACIA ALISE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:ALISE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:STACIA
Other - Middle Name:ALISE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2000 INTEGRITY DRIVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209
Mailing Address - Country:US
Mailing Address - Phone:614-445-7447
Mailing Address - Fax:614-445-7726
Practice Address - Street 1:2000 INTEGRITY DR S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2740
Practice Address - Country:US
Practice Address - Phone:614-445-7447
Practice Address - Fax:614-445-7726
Is Sole Proprietor?:No
Enumeration Date:2008-10-18
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1600093101YP2500X
390200000X
OHE.1600093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847147Medicaid