Healthcare Provider Details

I. General information

NPI: 1548601065
Provider Name (Legal Business Name): LETECIA A CRAWFORD CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2458 CALAMARI CT
NORTH CHARLESTON SC
29406-9337
US

IV. Provider business mailing address

2458 CALAMARI COURT
NORTH CHARLESTON SC
29406
US

V. Phone/Fax

Practice location:
  • Phone: 843-343-0331
  • Fax:
Mailing address:
  • Phone: 843-343-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberT118922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: