Provider Demographics
NPI:1194818096
Name:CRAWFORD, MARIE EILEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:EILEEN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 BLUFF CITY HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4637
Mailing Address - Country:US
Mailing Address - Phone:423-217-1097
Mailing Address - Fax:423-217-1069
Practice Address - Street 1:739 BLUFF CITY HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4637
Practice Address - Country:US
Practice Address - Phone:423-217-1097
Practice Address - Fax:423-217-1069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC1757101Y00000X
FLLMHC2593101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2593OtherLMHC
TN1757OtherLPC