Provider Demographics
NPI:1184173510
Name:CRAWFORD, KESLEY (EDD, CCJAP)
Entity type:Individual
Prefix:
First Name:KESLEY
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:EDD, CCJAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4889 LAKE WORTH RD
Mailing Address - Street 2:SUITE #109
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3499
Mailing Address - Country:US
Mailing Address - Phone:561-702-0528
Mailing Address - Fax:
Practice Address - Street 1:4889 LAKE WORTH RD
Practice Address - Street 2:SUITE #109
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3499
Practice Address - Country:US
Practice Address - Phone:561-702-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)