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General NPI Number Information
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NPI Number | 1245347335
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Entity Type | Individual
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Provider Name | ELAINE SHARON CRUMMETT L.P.A., L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 1706 DAVIE AVE SUITE D
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City | STATESVILLE
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State | NC
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Zip | 28677-3589
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Country | US
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Telephone | 704-880-2384
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Fax | 704-873-7789
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Provider Business Mailing Address
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Address Line | 1706 DAVIE AVE SUITE D
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City | STATESVILLE
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State | NC
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Zip | 28677-3589
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Country | US
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Telephone | 704-880-2384
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Fax | 704-873-7789
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3287
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1443
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License Number State | NC
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