Healthcare Provider Details

I. General information

NPI: 1306626866
Provider Name (Legal Business Name): SHANEIRIA SCOTT CREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 BAY BRIDGE DR
GULF BREEZE FL
32561-4468
US

IV. Provider business mailing address

6550 ARLINGWOOD DR
MILTON FL
32570-3318
US

V. Phone/Fax

Practice location:
  • Phone: 850-741-5438
  • Fax:
Mailing address:
  • Phone: 706-590-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW24272
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: