Provider Demographics
NPI:1164843645
Name:CRAWFORD, ERICA RAE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:RAE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 JOE RAMSEY BOULEVARD
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401
Mailing Address - Country:US
Mailing Address - Phone:972-735-0445
Mailing Address - Fax:972-692-7861
Practice Address - Street 1:3101 JOE RAMSEY BOULEVARD
Practice Address - Street 2:SUITE 103A
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:972-735-0445
Practice Address - Fax:972-692-7861
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36579103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical