Provider Demographics
NPI:1811425564
Name:CRAWFORD, LISA (CSWA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CRUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 NW CARY ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:OR
Mailing Address - Zip Code:97496-8592
Mailing Address - Country:US
Mailing Address - Phone:501-791-6810
Mailing Address - Fax:
Practice Address - Street 1:101 NW CARY ST
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:OR
Practice Address - Zip Code:97496-8592
Practice Address - Country:US
Practice Address - Phone:501-791-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL107041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical