Healthcare Provider Details

I. General information

NPI: 1457742736
Provider Name (Legal Business Name): CHRISTINE NGOZIKA CROWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 PEACH ST STE 120
ERIE PA
16508-2768
US

IV. Provider business mailing address

PO BOX 3510
PITTSBURGH PA
15230-3510
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-4718
  • Fax: 814-455-7463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: