Healthcare Provider Details

I. General information

NPI: 1932580628
Provider Name (Legal Business Name): CHRISTINA GAIL CRAWFORD LAC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 KANIS RD
LITTLE ROCK AR
72205-6413
US

IV. Provider business mailing address

4 MONT BLANC COVE
MAUMELLE AR
72113
US

V. Phone/Fax

Practice location:
  • Phone: 501-603-1345
  • Fax: 501-570-5011
Mailing address:
  • Phone: 501-257-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2403001
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number644611
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA2403001
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: