Healthcare Provider Details

I. General information

NPI: 1720990427
Provider Name (Legal Business Name): CHRISTOPHER ELLIS CRAWFORD MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 SHADOW LAKE CIR
MOUNT PLEASANT SC
29464-9054
US

IV. Provider business mailing address

41 TIMMERMAN DR
CHARLESTON SC
29407-7321
US

V. Phone/Fax

Practice location:
  • Phone: 843-606-0790
  • Fax:
Mailing address:
  • Phone: 843-597-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11137
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: