Healthcare Provider Details

I. General information

NPI: 1316861412
Provider Name (Legal Business Name): CAROLINE BLAIR CRUMPLER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 BENSON DR
RALEIGH NC
27609-7386
US

IV. Provider business mailing address

3755 BENSON DR
RALEIGH NC
27609-7386
US

V. Phone/Fax

Practice location:
  • Phone: 919-514-3566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-31717
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22934
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: