Provider Demographics
NPI:1093389082
Name:CROWE, IAN WALKER (LGPC)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:WALKER
Last Name:CROWE
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVE NE APT BQ
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6230
Mailing Address - Country:US
Mailing Address - Phone:703-901-2154
Mailing Address - Fax:
Practice Address - Street 1:316 F ST NE STE 110
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4934
Practice Address - Country:US
Practice Address - Phone:703-901-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health