Provider Demographics
NPI:1558448142
Name:CRAWL, MELVINA DARICE (LPC , NCC, NCSC)
Entity Type:Individual
Prefix:MRS
First Name:MELVINA
Middle Name:DARICE
Last Name:CRAWL
Suffix:
Gender:F
Credentials:LPC , NCC, NCSC
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 488
Mailing Address - Street 2:18512 MAIN STREET
Mailing Address - City:WOODBURY
Mailing Address - State:GA
Mailing Address - Zip Code:30293-0488
Mailing Address - Country:US
Mailing Address - Phone:706-553-9667
Mailing Address - Fax:
Practice Address - Street 1:3 JACKSON STREET
Practice Address - Street 2:SUITE C
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263
Practice Address - Country:US
Practice Address - Phone:706-553-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional