Provider Demographics
NPI:1487818514
Name:CRAWFORD, CARRIE L (PCC-S)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:L
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-0081
Mailing Address - Country:US
Mailing Address - Phone:234-567-1067
Mailing Address - Fax:
Practice Address - Street 1:4392 STATE ROUTE 164
Practice Address - Street 2:
Practice Address - City:LEETONIA
Practice Address - State:OH
Practice Address - Zip Code:44431-9614
Practice Address - Country:US
Practice Address - Phone:330-427-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0001277S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health