Provider Demographics
NPI:1336438589
Name:CROMWELL, DAMEN RAHEEM SR (DR)
Entity Type:Individual
Prefix:
First Name:DAMEN
Middle Name:RAHEEM
Last Name:CROMWELL
Suffix:SR
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2223
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2223
Mailing Address - Country:US
Mailing Address - Phone:919-332-9294
Mailing Address - Fax:
Practice Address - Street 1:1201 AVERSBORO RD
Practice Address - Street 2:SUITE 106
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-5208
Practice Address - Country:US
Practice Address - Phone:919-332-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7929101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor