Provider Demographics
NPI:1134803158
Name:CRAWFORD, CANDY M (PHD)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:M
Last Name:CRAWFORD
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 1:9271 WILDCAT HILL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-3545
Mailing Address - Country:US
Mailing Address - Phone:215-219-4119
Mailing Address - Fax:
Practice Address - Street 1:9271 WILDCAT HILL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-3545
Practice Address - Country:US
Practice Address - Phone:215-219-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist