Provider Demographics
NPI:1275726184
Name:CRAWFORD, CHRISTA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:LYNN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHRISTA
Other - Middle Name:LYNN
Other - Last Name:KINZLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, LCSW
Mailing Address - Street 1:3012 ASBURY CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1455
Mailing Address - Country:US
Mailing Address - Phone:229-333-0300
Mailing Address - Fax:229-333-0306
Practice Address - Street 1:2914 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1718
Practice Address - Country:US
Practice Address - Phone:229-333-0300
Practice Address - Fax:229-333-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110785AMedicaid
GAQ49147Medicare UPIN