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General NPI Number Information
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NPI Number | 1700678984
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Entity Type | Individual
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Provider Name | SUDABEH CROUCH NBHWC
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Gender | Female
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 06/15/2025
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Provider Practice Location Address
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Address Line | 289 S CULVER ST
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4805
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Country | US
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Telephone | 800-516-0975
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Fax |
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Provider Business Mailing Address
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Address Line | 310 ASCENSION TRL
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City | CLEVELAND
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State | GA
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Zip | 30528-7308
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Country | US
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Telephone | 706-969-3050
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Fax |
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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