Provider Demographics
NPI:1861468795
Name:CRAWLEY, SUSAN B (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 COPPERFIELD BLVD NE
Mailing Address - Street 2:NE PSYCH
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2402
Mailing Address - Country:US
Mailing Address - Phone:704-262-1800
Mailing Address - Fax:704-262-1836
Practice Address - Street 1:380 COPPERFIELD BLVD NE
Practice Address - Street 2:NE PSYCH
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:704-262-1800
Practice Address - Fax:704-262-1836
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000581Medicaid
NC6000581Medicaid
NCP33084Medicare UPIN