Healthcare Provider Details

I. General information

NPI: 1386946457
Provider Name (Legal Business Name): LAURIE-ANNE CRESPO LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE-ANNE WALTON LICSW, LCSW

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 HAMILTON CREEK DRIVE
MOBILE AL
36695
US

IV. Provider business mailing address

1956 UNIVERSITY BLVD SOUTH SUITE J-297
MOBILE AL
36609
US

V. Phone/Fax

Practice location:
  • Phone: 251-268-9944
  • Fax: 251-450-5596
Mailing address:
  • Phone: 251-268-9944
  • Fax: 251-706-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW3993C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSWSW9139
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: