Healthcare Provider Details

I. General information

NPI: 1396600680
Provider Name (Legal Business Name): ALISHIA LATRICE CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 N CASHUA DR
FLORENCE SC
29501-6939
US

IV. Provider business mailing address

2115 HARBOUR LN
FLORENCE SC
29505-7560
US

V. Phone/Fax

Practice location:
  • Phone: 866-850-6585
  • Fax:
Mailing address:
  • Phone: 866-850-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number56132
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: