Provider Demographics
NPI:1467094292
Name:CRAWFORD, DIAMOND ANTONIA
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:ANTONIA
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 1:2422 WISTERIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4866
Mailing Address - Country:US
Mailing Address - Phone:504-491-5778
Mailing Address - Fax:
Practice Address - Street 1:6305 ELYSIAN FIELDS AVE STE 404
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-4293
Practice Address - Country:US
Practice Address - Phone:504-281-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator