Provider Demographics
NPI:1780456178
Name:CRAWFORD, BRENDA (MSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4392 WINDSOR OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2385
Mailing Address - Country:US
Mailing Address - Phone:925-550-0506
Mailing Address - Fax:
Practice Address - Street 1:4823 N ROYAL ATLANTA DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3806
Practice Address - Country:US
Practice Address - Phone:925-550-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
INTERN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor