Provider Demographics
NPI:1083019491
Name:CRENSHAW, MOSES L III (BS)
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:L
Last Name:CRENSHAW
Suffix:III
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4342
Mailing Address - Country:US
Mailing Address - Phone:302-494-2094
Mailing Address - Fax:
Practice Address - Street 1:611 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4342
Practice Address - Country:US
Practice Address - Phone:302-494-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor