Healthcare Provider Details

I. General information

NPI: 1912118787
Provider Name (Legal Business Name): SHERYL CRAWFORD MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WINN WAY
DECATUR GA
30030-1707
US

IV. Provider business mailing address

586 WINDCHASE LN
STONE MOUNTAIN GA
30083-6303
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-7700
  • Fax:
Mailing address:
  • Phone: 404-299-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC004329
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: