Provider Demographics
NPI:1477845238
Name:CRAWFORD-CAMBELL, GEORGIA RUTH (CSW, MSW, M A)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:RUTH
Last Name:CRAWFORD-CAMBELL
Suffix:
Gender:F
Credentials:CSW, MSW, M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18401 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2837
Mailing Address - Country:US
Mailing Address - Phone:313-272-6232
Mailing Address - Fax:
Practice Address - Street 1:2265 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1168
Practice Address - Country:US
Practice Address - Phone:313-272-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010574311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical