Provider Demographics
NPI:1487817243
Name:CRUMMETT ASSOCIATES, PA
Entity Type:Organization
Organization Name:CRUMMETT ASSOCIATES, PA
Other - Org Name:ELAINE CRUMMETT, LPA, LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGICAL ASSOCIATE
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:CRUMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPA, LPC
Authorized Official - Phone:704-880-2384
Mailing Address - Street 1:908 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3532
Mailing Address - Country:US
Mailing Address - Phone:704-880-2517
Mailing Address - Fax:
Practice Address - Street 1:408 E BROAD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5329
Practice Address - Country:US
Practice Address - Phone:794-880-2384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1443 AND 3287261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1245347335OtherINDIVIDUAL NPI