Healthcare Provider Details

I. General information

NPI: 1194818096
Provider Name (Legal Business Name): MARIE EILEEN CRAWFORD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 BLUFF CITY HWY SUITE 5
BRISTOL TN
37620-4637
US

IV. Provider business mailing address

739 BLUFF CITY HWY SUITE 5
BRISTOL TN
37620-4637
US

V. Phone/Fax

Practice location:
  • Phone: 423-217-1097
  • Fax: 423-217-1069
Mailing address:
  • Phone: 423-217-1097
  • Fax: 423-217-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC1757
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMHC2593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: