Provider Demographics
NPI:1598433807
Name:TRUESDALE-CRAWFORD, MALISSA (LPC)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:
Last Name:TRUESDALE-CRAWFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 S RHETT AVE UNIT 5207
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-6911
Mailing Address - Country:US
Mailing Address - Phone:803-804-5199
Mailing Address - Fax:
Practice Address - Street 1:104 WAXHAW PROFESSIONAL PARK DR STE D
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-5020
Practice Address - Country:US
Practice Address - Phone:980-368-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17097101YM0800X
SC9097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health