Provider Demographics
NPI:1417545906
Name:CRAWFORD NAVARRETE, ELISSA ANN (LAPC)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:ANN
Last Name:CRAWFORD NAVARRETE
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:ANN
Other - Last Name:NAVARRETE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAPC
Mailing Address - Street 1:4295 PERRINTON TRL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8922
Mailing Address - Country:US
Mailing Address - Phone:317-850-0412
Mailing Address - Fax:
Practice Address - Street 1:368 W PIKE ST STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3240
Practice Address - Country:US
Practice Address - Phone:470-344-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty