Healthcare Provider Details

I. General information

NPI: 1730457532
Provider Name (Legal Business Name): AYESHA CRAWFORD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 LOOKOUT PL STE 202
MAITLAND FL
32751-4485
US

IV. Provider business mailing address

8140 ASHTON AVE SUITE 200
MANASSAS VA
20109-5698
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax: 407-232-9437
Mailing address:
  • Phone: 703-330-9933
  • Fax: 703-368-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004914
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: