Provider Demographics
NPI:1396871976
Name:CRENSHAW, DAVID L (DMIN LMFT LCAS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:CRENSHAW
Suffix:
Gender:M
Credentials:DMIN LMFT LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 WELLINGTON AVE STE H
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7704
Mailing Address - Country:US
Mailing Address - Phone:910-793-6144
Mailing Address - Fax:910-793-6140
Practice Address - Street 1:1606 WELLINGTON AVE STE H
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7704
Practice Address - Country:US
Practice Address - Phone:910-793-6144
Practice Address - Fax:910-793-6140
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC525106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA0070OtherMEDCOST
NC131CJOtherBCBS
NCA0070OtherMEDCOST