Healthcare Provider Details

I. General information

NPI: 1134787674
Provider Name (Legal Business Name): TASHINIKA CROWLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date: 11/13/2019
Reactivation Date: 03/25/2020

III. Provider practice location address

108 CHARTLEIGH CIR
CANTON MS
39046-1210
US

IV. Provider business mailing address

108 CHARTLEIGH CIR
CANTON MS
39046-1210
US

V. Phone/Fax

Practice location:
  • Phone: 601-720-9945
  • Fax:
Mailing address:
  • Phone: 601-720-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2393
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5439
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90614
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9001
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: