Healthcare Provider Details

I. General information

NPI: 1760650626
Provider Name (Legal Business Name): EDWIN EARL CRENSHAW JR. M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 COVEWOOD RD
ASHEVILLE NC
28805-1010
US

IV. Provider business mailing address

7 COVEWOOD RD
ASHEVILLE NC
28805-1010
US

V. Phone/Fax

Practice location:
  • Phone: 828-505-1605
  • Fax:
Mailing address:
  • Phone: 828-505-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1024
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1024
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1024
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1024
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1024
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1024
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1024
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1024
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1024
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: