Healthcare Provider Details

I. General information

NPI: 1609299445
Provider Name (Legal Business Name): NGONZI TRUTH CRUSHSHON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 CLAIRMONT RD STE 108
DECATUR GA
30033-4636
US

IV. Provider business mailing address

1549 CLAIRMONT RD STE 108
DECATUR GA
30033-4636
US

V. Phone/Fax

Practice location:
  • Phone: 732-733-6413
  • Fax:
Mailing address:
  • Phone: 732-733-6413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: