Healthcare Provider Details

I. General information

NPI: 1710059654
Provider Name (Legal Business Name): DAWN CRUMP L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 EBENEZER RD
ROCK HILL SC
29732-0510
US

IV. Provider business mailing address

P O BOX 36624
ROCK HILL SC
29732-0510
US

V. Phone/Fax

Practice location:
  • Phone: 803-327-4357
  • Fax:
Mailing address:
  • Phone: 803-327-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4167
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: