Provider Demographics
NPI:1740485242
Name:CREWS, CARMELLA DIXON (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:CARMELLA
Middle Name:DIXON
Last Name:CREWS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-0142
Mailing Address - Country:US
Mailing Address - Phone:704-951-4053
Mailing Address - Fax:267-427-8628
Practice Address - Street 1:17824 STATESVILLE RD STE 123
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6101
Practice Address - Country:US
Practice Address - Phone:704-951-4053
Practice Address - Fax:267-427-8628
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102807Medicaid