Provider Demographics
NPI:1760953269
Name:CRAWFORD, KRISTEN KELLY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:KELLY
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:KELLY
Other - Last Name:AMERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:838 CLARION WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6110
Mailing Address - Country:US
Mailing Address - Phone:478-731-4263
Mailing Address - Fax:
Practice Address - Street 1:120 E TRINITY PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3302
Practice Address - Country:US
Practice Address - Phone:404-378-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0054141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical