Provider Demographics
NPI:1245016807
Name:JAMES-CRENSHAW, ITEISHA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ITEISHA
Middle Name:
Last Name:JAMES-CRENSHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S SYCAMORE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5044
Mailing Address - Country:US
Mailing Address - Phone:804-894-8829
Mailing Address - Fax:804-535-4955
Practice Address - Street 1:510 S SYCAMORE ST STE 3
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5044
Practice Address - Country:US
Practice Address - Phone:804-894-8829
Practice Address - Fax:804-535-4955
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906010747251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health