Healthcare Provider Details

I. General information

NPI: 1629563606
Provider Name (Legal Business Name): DARREN CRENSHAW ORDAINED MINISTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E FRANKLIN ST STE B
RICHMOND VA
23219-2107
US

IV. Provider business mailing address

206 HOSPITAL ST # 2C
RICHMOND VA
23219-1143
US

V. Phone/Fax

Practice location:
  • Phone: 443-868-8115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number05092019
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: