Provider Demographics
NPI:1689902181
Name:CRAWFORD, KIMBERLY TYRA (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:TYRA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 BARNACLE GEESE CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7102
Mailing Address - Country:US
Mailing Address - Phone:301-738-9691
Mailing Address - Fax:
Practice Address - Street 1:9975 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3316
Practice Address - Country:US
Practice Address - Phone:301-738-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG07056101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool