Provider Demographics
NPI:1477594018
Name:CROWSON, MARY MARSHALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARSHALL
Last Name:CROWSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 ANGUS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5402
Mailing Address - Country:US
Mailing Address - Phone:919-341-2611
Mailing Address - Fax:
Practice Address - Street 1:1611 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2888
Practice Address - Country:US
Practice Address - Phone:919-942-8596
Practice Address - Fax:919-929-0120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000532Medicaid