Provider Demographics
NPI:1851465207
Name:CREVELING, VIOLET V (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:V
Last Name:CREVELING
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8613
Mailing Address - Country:US
Mailing Address - Phone:770-618-3003
Mailing Address - Fax:770-956-2919
Practice Address - Street 1:2470 WINDY HILL RD SE
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8613
Practice Address - Country:US
Practice Address - Phone:770-618-3003
Practice Address - Fax:770-956-2919
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC001746OtherLICENSED PROFESSIONAL CO
23978OtherNATIONAL CERTIFIED COUN.