Provider Demographics
NPI:1689971590
Name:CROSSWHITE, DESIREE' BENFIELD (BSW, MS, LCSW)
Entity Type:Individual
Prefix:
First Name:DESIREE'
Middle Name:BENFIELD
Last Name:CROSSWHITE
Suffix:
Gender:F
Credentials:BSW, MS, LCSW
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 108
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-0108
Mailing Address - Country:US
Mailing Address - Phone:704-881-4657
Mailing Address - Fax:704-873-9672
Practice Address - Street 1:206 COOPER ST STE 117
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5897
Practice Address - Country:US
Practice Address - Phone:704-881-4657
Practice Address - Fax:704-873-9672
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0071541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007775Medicaid