Provider Demographics
NPI:1407268899
Name:CRAWFORD, BRANDI KC
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:KC
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:HAUULA
Mailing Address - State:HI
Mailing Address - Zip Code:96717-0899
Mailing Address - Country:US
Mailing Address - Phone:808-779-0473
Mailing Address - Fax:
Practice Address - Street 1:54-137 KAWAIPUNA ST
Practice Address - Street 2:
Practice Address - City:HAUULA
Practice Address - State:HI
Practice Address - Zip Code:96717-9511
Practice Address - Country:US
Practice Address - Phone:808-779-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI104100000X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker