Healthcare Provider Details

I. General information

NPI: 1720290984
Provider Name (Legal Business Name): WENDY CRAWFORD M.A., N.C.S.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 WASHINGTON BLVD
ARLINGTON VA
22204-5719
US

IV. Provider business mailing address

2110 WASHINGTON BLVD
ARLINGTON VA
22204-5719
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-6181
  • Fax:
Mailing address:
  • Phone: 703-228-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number803000225
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0803000225
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: