Provider Demographics
NPI:1295353605
Name:CRUMSEY, TYEISHA
Entity type:Individual
Prefix:
First Name:TYEISHA
Middle Name:
Last Name:CRUMSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WESTRIDGE PKWY STE 714
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7789
Mailing Address - Country:US
Mailing Address - Phone:404-919-1164
Mailing Address - Fax:
Practice Address - Street 1:600 WESTRIDGE PKWY STE 714
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7789
Practice Address - Country:US
Practice Address - Phone:404-919-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health