Healthcare Provider Details

I. General information

NPI: 1366424566
Provider Name (Legal Business Name): CLAUDIA CRENSHAW RN,PHD,APRN,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WEST PONCE DE LEON AVE SUITE 540
DECATUR GA
30030
US

IV. Provider business mailing address

315 WEST PONCE DE LEON AVE SUITE 540
DECATUR GA
30030
US

V. Phone/Fax

Practice location:
  • Phone: 404-403-2669
  • Fax: 404-373-7647
Mailing address:
  • Phone: 404-403-2669
  • Fax: 404-373-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1115
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1115
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN052883
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN052883
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN052883
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: