Provider Demographics
NPI:1225327679
Name:CRUMBLEY, ANICKELETTE O (LPC)
Entity Type:Individual
Prefix:MISS
First Name:ANICKELETTE
Middle Name:O
Last Name:CRUMBLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 HIGHPOINT CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3175
Mailing Address - Country:US
Mailing Address - Phone:678-499-5669
Mailing Address - Fax:
Practice Address - Street 1:3293 HIGHPOINT CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3175
Practice Address - Country:US
Practice Address - Phone:678-499-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional