Provider Demographics
NPI:1265426944
Name:CRAWFORD, JEFFREY LLOYD (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LLOYD
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 TALBOT LN
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9165
Mailing Address - Country:US
Mailing Address - Phone:704-300-2290
Mailing Address - Fax:828-294-0367
Practice Address - Street 1:311-4E JUDGES ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3655
Practice Address - Country:US
Practice Address - Phone:910-791-6767
Practice Address - Fax:910-791-6890
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0411LOtherBCBSNC
NC6000657Medicaid
NC6000657Medicaid
NC0411LOtherBCBSNC