Provider Demographics
NPI:1245347335
Name:CRUMMETT, ELAINE SHARON (LPA, LPC)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:SHARON
Last Name:CRUMMETT
Suffix:
Gender:F
Credentials:LPA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 DAVIE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3589
Mailing Address - Country:US
Mailing Address - Phone:704-880-2384
Mailing Address - Fax:704-873-7789
Practice Address - Street 1:1706 DAVIE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3589
Practice Address - Country:US
Practice Address - Phone:704-880-2384
Practice Address - Fax:704-873-7789
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3287101YP2500X
NC1443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11856OtherBC/BS