Provider Demographics
NPI:1831739689
Name:S. NICOLE CRAWFORD, LCSW, PLLC
Entity type:Organization
Organization Name:S. NICOLE CRAWFORD, LCSW, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEDETRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMERALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-777-2404
Mailing Address - Street 1:11135 FANTASY TRL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-5514
Mailing Address - Country:US
Mailing Address - Phone:502-777-2404
Mailing Address - Fax:888-607-7352
Practice Address - Street 1:3715 BARDSTOWN RD STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2268
Practice Address - Country:US
Practice Address - Phone:502-777-2404
Practice Address - Fax:888-607-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty