Provider Demographics
NPI:1346455060
Name:CRAWFORD, RONNIE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 COUNTY ROAD 6100
Mailing Address - Street 2:
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824-8516
Mailing Address - Country:US
Mailing Address - Phone:662-365-5153
Mailing Address - Fax:
Practice Address - Street 1:269 COUNTY ROAD 6100
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-8516
Practice Address - Country:US
Practice Address - Phone:662-365-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCO4711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical