Provider Demographics
NPI:1992031892
Name:CRAWFORD, T-REX (ABD, LCAS, CSI, LCSW)
Entity Type:Individual
Prefix:
First Name:T-REX
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:ABD, LCAS, CSI, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-0698
Mailing Address - Country:US
Mailing Address - Phone:919-222-1297
Mailing Address - Fax:855-329-8739
Practice Address - Street 1:103 ORMOND AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4832
Practice Address - Country:US
Practice Address - Phone:919-222-1297
Practice Address - Fax:855-329-8739
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011101YA0400X
NCC0077651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007449Medicaid