Healthcare Provider Details

I. General information

NPI: 1962367649
Provider Name (Legal Business Name): ERIKA NICOLE CRUMWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402B LEGACY PARK
RIDGELAND MS
39157-4315
US

IV. Provider business mailing address

3549 RITA DR
JACKSON MS
39213-5134
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-7154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-439139
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: