Healthcare Provider Details

I. General information

NPI: 1760948418
Provider Name (Legal Business Name): ADIA JOY CRAWFORD LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 LEAH LN
SPRING GROVE PA
17362-8456
US

IV. Provider business mailing address

155 LEAH LN
SPRING GROVE PA
17362-8456
US

V. Phone/Fax

Practice location:
  • Phone: 443-928-8929
  • Fax:
Mailing address:
  • Phone: 443-928-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12835
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: