Provider Demographics
NPI:1598012403
Name:CRAWFORD-BROWN, ILISHA T (MS)
Entity Type:Individual
Prefix:
First Name:ILISHA
Middle Name:T
Last Name:CRAWFORD-BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5862 CATALINA LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32443-2290
Mailing Address - Country:US
Mailing Address - Phone:850-557-3759
Mailing Address - Fax:
Practice Address - Street 1:5862 CATALINA LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:FL
Practice Address - Zip Code:32443-2290
Practice Address - Country:US
Practice Address - Phone:850-557-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health