Provider Demographics
NPI:1841222692
Name:CRAWFORD, ANGELINE RAINEY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINE
Middle Name:RAINEY
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-2544
Mailing Address - Country:US
Mailing Address - Phone:904-557-5288
Mailing Address - Fax:
Practice Address - Street 1:501 CENTRE ST STE 117
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3936
Practice Address - Country:US
Practice Address - Phone:904-557-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X
FLMH12290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional